401k Plan data: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN plan

BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN
Plan identification number	501

BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

BERNARD ROBINSON & COMPANY, L.L.P. has sponsored the creation of one or more 401k plans.

Company Name: BERNARD ROBINSON & COMPANY, L.L.P.

Employer identification number (EIN): 560571159

NAIC Classification: 541211
NAIC Description: Offices of Certified Public Accountants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 RHONDA SKILES
501 2017-01-01 RHONDA SKILES

Plan Statistics for BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN

401k plan membership statisitcs for BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN

Measure Date Value
2022: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 162
Total of all active and inactive participants 2022-01-01 162
2021: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 152
Total of all active and inactive participants 2021-01-01 152
2020: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 155
Total of all active and inactive participants 2020-01-01 155
2019: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 150
Total of all active and inactive participants 2019-01-01 150
2018: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 132
Total of all active and inactive participants 2018-01-01 132
2017: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 125
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 2017-01-01 125

Measure	Date	Value
2022: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	162
Total of all active and inactive participants	2022-01-01	162
2021: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	152
Total of all active and inactive participants	2021-01-01	152
2020: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	155
Total of all active and inactive participants	2020-01-01	155
2019: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	150
Total of all active and inactive participants	2019-01-01	150
2018: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	132
Total of all active and inactive participants	2018-01-01	132
2017: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	125
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	125

Form 5500 Responses for BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN

2022: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: BERNARD ROBINSON & COMPANY LLP HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	162
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $560
Total amount of fees paid to insurance company	USD $55
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $311
Amount paid for insurance broker fees	55

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00544331

Policy instance

Insurance contract or identification number	00544331
Number of Individuals Covered	65
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,070
Total amount of fees paid to insurance company	USD $1,262
Other welfare benefits provided	ACCIDENT, VOLUNTARY CRITICAL ILLNES
Welfare Benefit Premiums Paid to Carrier	USD $30,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,070
Amount paid for insurance broker fees	1262

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D038347

Policy instance

Insurance contract or identification number	1D038347
Number of Individuals Covered	102
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,035
Total amount of fees paid to insurance company	USD $5,017
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,035
Amount paid for insurance broker fees	5017
Additional information about fees paid to insurance broker	ENROLLMENT

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	151
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,547
Total amount of fees paid to insurance company	USD $799
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,928
Amount paid for insurance broker fees	799

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,168
Total amount of fees paid to insurance company	USD $1,427
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,093
Amount paid for insurance broker fees	1427

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	162
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,130
Total amount of fees paid to insurance company	USD $964
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,420
Amount paid for insurance broker fees	964

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00634239

Policy instance

Insurance contract or identification number	00634239
Number of Individuals Covered	138
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $42,153
Total amount of fees paid to insurance company	USD $3,645
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $428,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,153
Amount paid for insurance broker fees	3645
Additional information about fees paid to insurance broker	INCENTIVE COMPENSATION PAYMENTS BASED ON MEMBERSHIP IN YOUR PLAN OR L

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

14164380-1001

Policy instance

Insurance contract or identification number	14164380-1001
Number of Individuals Covered	105
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,733
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,733

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	152
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $404
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $224

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

14164380-1001

Policy instance

Insurance contract or identification number	14164380-1001
Number of Individuals Covered	145
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $33,838
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,413,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,838

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	151
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,217
Total amount of fees paid to insurance company	USD $67
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,730
Amount paid for insurance broker fees	67

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	151
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,594
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,729

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	130
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,913
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,507

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D038347

Policy instance

Insurance contract or identification number	1D038347
Number of Individuals Covered	99
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,561
Total amount of fees paid to insurance company	USD $4,781
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,561
Amount paid for insurance broker fees	4781
Additional information about fees paid to insurance broker	ENROLLMENT

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00544331

Policy instance

Insurance contract or identification number	00544331
Number of Individuals Covered	61
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,156
Total amount of fees paid to insurance company	USD $1,776
Other welfare benefits provided	ACCIDENT, VOLUNTARY CRITICAL ILLNES
Welfare Benefit Premiums Paid to Carrier	USD $31,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,156
Amount paid for insurance broker fees	1776

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	155
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $452
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $251

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	155
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,707
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,138

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	132
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,282
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,601

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	147
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,188
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,713

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

V81627

Policy instance

Insurance contract or identification number	V81627
Number of Individuals Covered	89
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,444
Total amount of fees paid to insurance company	USD $0
Vision 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 $1,444

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D038347

Policy instance

Insurance contract or identification number	1D038347
Number of Individuals Covered	97
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,151
Total amount of fees paid to insurance company	USD $6,056
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,106
Amount paid for insurance broker fees	2676
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

081627

Policy instance

Insurance contract or identification number	081627
Number of Individuals Covered	141
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $42,668
Total amount of fees paid to insurance company	USD $478
Health 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 $42,668
Amount paid for insurance broker fees	478

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	150
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,175
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,783

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

1D038347

Policy instance

Insurance contract or identification number	1D038347
Number of Individuals Covered	95
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,401
Total amount of fees paid to insurance company	USD $8,663
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,401
Amount paid for insurance broker fees	3700
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

081627

Policy instance

Insurance contract or identification number	081627
Number of Individuals Covered	136
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $40,144
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,200,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,144

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	150
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $234

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	131
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,643
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,246

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	141
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,323
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,194

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

V81627

Policy instance

Insurance contract or identification number	V81627
Number of Individuals Covered	87
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,206
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,206

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

081627

Policy instance

Insurance contract or identification number	081627
Number of Individuals Covered	123
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $35,432
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,044,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,432

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	137
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $360
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $200

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	132
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,828
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,552

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	112
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,397
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,554

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	130
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,727
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,836

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $15
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $152
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

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

V81627

Policy instance

Insurance contract or identification number	V81627
Number of Individuals Covered	59
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $777
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $777

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00544331

Policy instance

Insurance contract or identification number	00544331
Number of Individuals Covered	96
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $20,040
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,040

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

081627

Policy instance

Insurance contract or identification number	081627
Number of Individuals Covered	116
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $33,990
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $822,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,990
Insurance broker name	DREW M LAMB

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	124
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $337
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $150
Insurance broker name	CP GREENSBORO INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	125
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,007
Total amount of fees paid to insurance company	USD $2,014
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1204
Commission paid to Insurance Broker	USD $1,007
Insurance broker name	CP GREENSBORO INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	108
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,915
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,629
Insurance broker name	CP GREENSBORO INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	86
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,650
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $660
Insurance broker name	CP GREENSBORO INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50001487

Policy instance

Insurance contract or identification number	50001487
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16
Insurance broker name	BB&T INSURANCE SERVICES INC

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

23150

Policy instance

Insurance contract or identification number	23150
Number of Individuals Covered	146
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,078
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,078
Insurance broker name	CP GREENSBORO INC

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Company Name:	BERNARD ROBINSON & COMPANY, L.L.P.
Employer identification number (EIN):	560571159
NAIC Classification:	541211
NAIC Description:	Offices of Certified Public Accountants