MARQUIS INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Additional information about MARQUIS INDUSTRIES, INC.
Submission information for form 5500 for 401k plan MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH
401k plan membership statisitcs for MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH
| Measure | Date | Value |
|---|
| 2022: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 330 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 353 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 353 |
| 2021: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 330 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 330 |
| 2020: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 307 |
| Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
| Total of all active and inactive participants | 2020-03-01 | 307 |
| 2019: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 242 |
| Number of retired or separated participants receiving benefits | 2019-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-03-01 | 0 |
| Total of all active and inactive participants | 2019-03-01 | 242 |
| 2018: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 272 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
| Total of all active and inactive participants | 2018-03-01 | 272 |
| 2017: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 203 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
| Total of all active and inactive participants | 2017-03-01 | 203 |
| 2016: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 199 |
| Number of retired or separated participants receiving benefits | 2016-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
| Total of all active and inactive participants | 2016-03-01 | 199 |
| 2015: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 185 |
| Number of retired or separated participants receiving benefits | 2015-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
| Total of all active and inactive participants | 2015-03-01 | 185 |
| 2014: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 174 |
| Number of retired or separated participants receiving benefits | 2014-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-03-01 | 0 |
| Total of all active and inactive participants | 2014-03-01 | 174 |
| 2013: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 186 |
| Total of all active and inactive participants | 2013-03-01 | 186 |
| 2012: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 175 |
| Total of all active and inactive participants | 2012-03-01 | 175 |
| Measure | Date | Value |
|---|
| 2023 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2023 401k financial data |
|---|
| Total income from all sources | 2023-02-28 | $0 |
| Total plan assets at end of year | 2023-02-28 | $0 |
| Total plan assets at beginning of year | 2023-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2023-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-02-28 | $0 |
| 2022 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2022 401k financial data |
|---|
| Total income from all sources | 2022-02-28 | $0 |
| Total plan assets at end of year | 2022-02-28 | $0 |
| Total plan assets at beginning of year | 2022-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2022-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-02-28 | $0 |
| 2021 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2021 401k financial data |
|---|
| Total income from all sources | 2021-02-28 | $0 |
| Total plan assets at end of year | 2021-02-28 | $0 |
| Total plan assets at beginning of year | 2021-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-02-28 | $0 |
| 2020 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2020 401k financial data |
|---|
| Total income from all sources | 2020-02-29 | $0 |
| Total plan assets at end of year | 2020-02-29 | $0 |
| Total plan assets at beginning of year | 2020-02-29 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-02-29 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-02-29 | $0 |
| 2019 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2019 401k financial data |
|---|
| Total income from all sources | 2019-02-28 | $0 |
| Total plan assets at end of year | 2019-02-28 | $0 |
| Total plan assets at beginning of year | 2019-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-02-28 | $0 |
| 2018 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2018 401k financial data |
|---|
| Total income from all sources | 2018-02-28 | $0 |
| Total plan assets at end of year | 2018-02-28 | $0 |
| Total plan assets at beginning of year | 2018-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-02-28 | $0 |
| 2017 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2017 401k financial data |
|---|
| Total income from all sources | 2017-02-28 | $0 |
| Total plan assets at end of year | 2017-02-28 | $0 |
| Total plan assets at beginning of year | 2017-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-02-28 | $0 |
| 2016 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2016 401k financial data |
|---|
| Total income from all sources | 2016-02-29 | $0 |
| Total plan assets at end of year | 2016-02-29 | $0 |
| Total plan assets at beginning of year | 2016-02-29 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-02-29 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-02-29 | $0 |
| 2015 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2015 401k financial data |
|---|
| Total income from all sources | 2015-02-28 | $0 |
| Total plan assets at end of year | 2015-02-28 | $0 |
| Total plan assets at beginning of year | 2015-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-02-28 | $0 |
| 2014 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2014 401k financial data |
|---|
| Total income from all sources | 2014-02-28 | $0 |
| Total plan assets at end of year | 2014-02-28 | $0 |
| Total plan assets at beginning of year | 2014-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2014-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-02-28 | $0 |
| 2013 : MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2013 401k financial data |
|---|
| Total income from all sources | 2013-02-28 | $0 |
| Total plan assets at end of year | 2013-02-28 | $0 |
| Total plan assets at beginning of year | 2013-02-28 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2013-02-28 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-02-28 | $0 |
| 2022: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2022 form 5500 responses |
|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2021 form 5500 responses |
|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2020 form 5500 responses |
|---|
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | Plan funding arrangement – Insurance | Yes |
| 2020-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2019 form 5500 responses |
|---|
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | Plan funding arrangement – Insurance | Yes |
| 2019-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – Insurance | Yes |
| 2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – Insurance | Yes |
| 2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – Insurance | Yes |
| 2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – Insurance | Yes |
| 2013-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: MARQUIS INDUSTRIES, INC. WELFARE BENEFIT PLAN - HEALTH 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | First time form 5500 has been submitted | Yes |
| 2012-03-01 | Plan funding arrangement – Insurance | Yes |
| 2012-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625551 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625551 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $4 | | Total amount of fees paid to insurance company | USD $122,452 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,060,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 122452 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR FEES | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $4 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625551 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625551 | | Number of Individuals Covered | 330 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $17,182 | | Total amount of fees paid to insurance company | USD $101,659 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,713,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 100936 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR FEES | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $17,182 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625551 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625551 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $15,603 | | Total amount of fees paid to insurance company | USD $117,405 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,415,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,603 | | Amount paid for insurance broker fees | 112240 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR FEES | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 87203 |
| Policy instance | 2 |
| Insurance contract or identification number | 87203 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $3,220 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $17,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,220 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625551 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625551 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $9,585 | | Total amount of fees paid to insurance company | USD $84,765 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,791,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,585 | | Amount paid for insurance broker fees | 84765 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053848000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $73,640 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,508,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,624 | | Insurance broker name | ADCOCK FINANCIAL GROUP, INC. |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053848000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $61,264 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,081,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,264 | | Insurance broker name | ADCOCK FINANCIAL GROUP, INC. |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1053848000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $2,649 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,649 | | Insurance broker name | ADCOCK FINANCIAL GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053848000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $57,988 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $934,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,988 | | Insurance broker name | ADCOCK FINANCIAL GROUP, INC. |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1053848000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $3,152 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,152 | | Insurance broker name | ADCOCK FINANCIAL GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053848000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $59,884 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $645,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,884 | | Insurance broker name | ADCOCK FINANCIAL GROUP, INC. |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1053848000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $2,753 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,753 | | Insurance broker name | ADCOCK FINANCIAL GROUP |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1053848000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1053848000 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $52,299 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $569,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,299 | | Insurance broker name | ADCOCK FINANCIAL GROUP, INC. |
|
