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FMC SERVICES, LLC. HEALTH BENEFIT PLAN 401k Plan overview

Plan NameFMC SERVICES, LLC. HEALTH BENEFIT PLAN
Plan identification number 501

FMC SERVICES, LLC. HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

FMC SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name:FMC SERVICES, LLC
Employer identification number (EIN):465766063
NAIC Classification:541600

Additional information about FMC SERVICES, LLC

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 2013-05-30
Company Identification Number: 20131325149
Legal Registered Office Address: 4775 TOPAZ STREET APT. 112

LAS VEGAS
United States of America (USA)
89121

More information about FMC SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FMC SERVICES, LLC. HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012019-01-01
5012018-01-01
5012017-01-01JANICE HODGES
5012016-01-01JANICE HODGES
5012016-01-01
5012015-01-01JANICE HODGES

Plan Statistics for FMC SERVICES, LLC. HEALTH BENEFIT PLAN

401k plan membership statisitcs for FMC SERVICES, LLC. HEALTH BENEFIT PLAN

Measure Date Value
2022: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01237
Total number of active participants reported on line 7a of the Form 55002022-01-01259
Total of all active and inactive participants2022-01-01259
2021: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01238
Total number of active participants reported on line 7a of the Form 55002021-01-01233
Total of all active and inactive participants2021-01-01233
2019: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01235
Total number of active participants reported on line 7a of the Form 55002019-01-01244
Total of all active and inactive participants2019-01-01244
2018: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01224
Total number of active participants reported on line 7a of the Form 55002018-01-01234
Total of all active and inactive participants2018-01-01234
2017: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01230
Total number of active participants reported on line 7a of the Form 55002017-01-01217
Total of all active and inactive participants2017-01-01217
Total participants2017-01-01217
2016: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01184
Total number of active participants reported on line 7a of the Form 55002016-01-01213
Total of all active and inactive participants2016-01-01213
Total participants2016-01-01213
2015: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01172
Total number of active participants reported on line 7a of the Form 55002015-01-01181
Total of all active and inactive participants2015-01-01181
Total participants2015-01-01181

Financial Data on FMC SERVICES, LLC. HEALTH BENEFIT PLAN

Measure Date Value
2022 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$3,871,695
Total of all expenses incurred2022-12-31$3,871,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$3,671,301
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$3,871,695
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$200,394
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,022,932
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$572,460
Administrative expenses (other) incurred2022-12-31$98,826
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$524,927
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$2,276,303
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,146,374
Contract administrator fees2022-12-31$101,568
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31Yes
2021 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$3,228,793
Total of all expenses incurred2021-12-31$3,228,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,051,039
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$3,228,793
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$177,754
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$407,995
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$431,188
Administrative expenses (other) incurred2021-12-31$88,767
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$458,361
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,389,610
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$2,592,678
Contract administrator fees2021-12-31$88,987
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31Yes
2019 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$2,256,149
Total of all expenses incurred2019-12-31$2,256,149
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$2,060,503
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$2,256,149
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$195,646
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,008,899
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$101,806
Administrative expenses (other) incurred2019-12-31$113,716
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$443,075
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$1,145,444
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,617,428
Contract administrator fees2019-12-31$81,930
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31Yes
2018 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2018 401k financial data
Total income from all sources (including contributions)2018-12-31$2,590,930
Total of all expenses incurred2018-12-31$2,590,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$2,406,927
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$2,590,930
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$184,003
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$873,844
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$201,511
Administrative expenses (other) incurred2018-12-31$109,874
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$441,533
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,515,575
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,965,394
Contract administrator fees2018-12-31$74,129
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31Yes
2017 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$2,950,239
Total of all expenses incurred2017-12-31$2,950,239
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$2,853,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$2,950,239
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$97,194
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$763,717
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$708,603
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$464,787
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,477,919
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$2,388,258
Contract administrator fees2017-12-31$97,194
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31Yes
2016 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$2,643,220
Total of all expenses incurred2016-12-31$2,643,220
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,511,407
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,643,220
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$131,813
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$584,996
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$784,718
Administrative expenses (other) incurred2016-12-31$43,119
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$392,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,273,506
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,119,067
Contract administrator fees2016-12-31$88,694
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31Yes
2015 : FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2015 401k financial data
Total income from all sources (including contributions)2015-12-31$1,303,100
Total of all expenses incurred2015-12-31$1,303,100
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,194,620
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,303,100
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$108,480
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$493,604
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$20,125
Administrative expenses (other) incurred2015-12-31$35,962
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$326,269
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$789,371
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$868,351
Contract administrator fees2015-12-31$72,518
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31Yes

Form 5500 Responses for FMC SERVICES, LLC. HEALTH BENEFIT PLAN

2022: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01First time form 5500 has been submittedYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: FMC SERVICES, LLC. HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS549549
Policy instance 2
Insurance contract or identification numberS549549
Number of Individuals Covered259
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,222
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $23,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,222
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberS549549
Policy instance 1
Insurance contract or identification numberS549549
Number of Individuals Covered259
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $79,002
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $501,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees26334
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS549549
Policy instance 2
Insurance contract or identification numberS549549
Number of Individuals Covered233
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,134
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $21,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,134
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberS549549
Policy instance 1
Insurance contract or identification numberS549549
Number of Individuals Covered233
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $72,071
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $437,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees24024
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS549549
Policy instance 2
Insurance contract or identification numberS549549
Number of Individuals Covered244
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,293
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $21,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,293
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberS549549
Policy instance 1
Insurance contract or identification numberS549549
Number of Individuals Covered244
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $78,379
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees26257
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS549549
Policy instance 2
Insurance contract or identification numberS549549
Number of Individuals Covered217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,853
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $20,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,853
Insurance broker organization code?3
Insurance broker nameUPSHAW INSURANCE AGENCY
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberS549549
Policy instance 1
Insurance contract or identification numberS549549
Number of Individuals Covered217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $64,425
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $444,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees21481
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberS549549
Policy instance 2
Insurance contract or identification numberS549549
Number of Individuals Covered181
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,585
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $15,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,585
Insurance broker organization code?3
Insurance broker nameUPSHAW INSURANCE AGENCY
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberS549549
Policy instance 1
Insurance contract or identification numberS549549
Number of Individuals Covered181
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $53,943
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees17981
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameDFB INSURANCE GROUP OF AMARILLO

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