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FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 401k Plan overview

Plan NameFOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN
Plan identification number 501

FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

FOUR SEASONS SALES & SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:FOUR SEASONS SALES & SERVICES, INC.
Employer identification number (EIN):621284383
NAIC Classification:424300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01
5012018-01-01VALERIE TAYLOR VALERIE TAYLOR2019-07-22
5012017-01-01VALERIE TAYLOR VALERIE TAYLOR2018-07-31
5012016-01-01VALERIE TAYLOR VALERIE TAYLOR2017-07-26
5012015-01-01VALERIE TAYLOR VALERIE TAYLOR2016-07-19
5012014-08-01VALERIE TAYLOR VALERIE TAYLOR2016-05-24
5012013-08-01VALERIE L. COLE VALERIE L. COLE2015-03-09
5012012-08-01VALERIE L. COLE VALERIE L. COLE2014-02-27
5012011-08-01VALERIE L. COLE VALERIE L. COLE2013-02-28
5012009-08-01VALERIE COLE
5012006-08-01VALERIE COLE
5012005-08-01VALERIE COLE
5012004-08-01VALERIE COLE
5012003-08-01VALERIE COLE

Plan Statistics for FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN

401k plan membership statisitcs for FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN

Measure Date Value
2019: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0176
Total number of active participants reported on line 7a of the Form 55002019-01-0192
Number of other retired or separated participants entitled to future benefits2019-01-011
Total of all active and inactive participants2019-01-0193
2018: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01104
Total number of active participants reported on line 7a of the Form 55002018-01-0174
Number of other retired or separated participants entitled to future benefits2018-01-012
Total of all active and inactive participants2018-01-0176
2017: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01105
Total number of active participants reported on line 7a of the Form 55002017-01-01104
Number of retired or separated participants receiving benefits2017-01-013
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-01111
2016: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01101
Total number of active participants reported on line 7a of the Form 55002016-01-01104
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-01105
2015: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01137
Total number of active participants reported on line 7a of the Form 55002015-01-01101
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-012
Total of all active and inactive participants2015-01-01105
2014: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01134
Total number of active participants reported on line 7a of the Form 55002014-08-01126
Number of retired or separated participants receiving benefits2014-08-011
Number of other retired or separated participants entitled to future benefits2014-08-0110
Total of all active and inactive participants2014-08-01137
2013: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01144
Total number of active participants reported on line 7a of the Form 55002013-08-01125
Number of retired or separated participants receiving benefits2013-08-012
Number of other retired or separated participants entitled to future benefits2013-08-017
Total of all active and inactive participants2013-08-01134
2012: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01145
Total number of active participants reported on line 7a of the Form 55002012-08-01144
Number of retired or separated participants receiving benefits2012-08-014
Number of other retired or separated participants entitled to future benefits2012-08-013
Total of all active and inactive participants2012-08-01151
2011: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01147
Total number of active participants reported on line 7a of the Form 55002011-08-01145
Number of retired or separated participants receiving benefits2011-08-011
Number of other retired or separated participants entitled to future benefits2011-08-014
Total of all active and inactive participants2011-08-01150
2009: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01163
Total number of active participants reported on line 7a of the Form 55002009-08-01270
Total of all active and inactive participants2009-08-01270
Total participants2009-08-01270
2006: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2006 401k membership
Total participants, beginning-of-year2006-08-01124
Total number of active participants reported on line 7a of the Form 55002006-08-01128
Number of retired or separated participants receiving benefits2006-08-010
Number of other retired or separated participants entitled to future benefits2006-08-010
Total of all active and inactive participants2006-08-01128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-08-010
Total participants2006-08-01128
Number of participants with account balances2006-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2006-08-010
2005: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2005 401k membership
Total participants, beginning-of-year2005-08-01118
Total number of active participants reported on line 7a of the Form 55002005-08-01124
Number of retired or separated participants receiving benefits2005-08-010
Number of other retired or separated participants entitled to future benefits2005-08-010
Total of all active and inactive participants2005-08-01124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2005-08-010
Total participants2005-08-01124
Number of participants with account balances2005-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2005-08-010
2004: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2004 401k membership
Total participants, beginning-of-year2004-08-01118
Total number of active participants reported on line 7a of the Form 55002004-08-01118
Number of retired or separated participants receiving benefits2004-08-010
Number of other retired or separated participants entitled to future benefits2004-08-010
Total of all active and inactive participants2004-08-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2004-08-010
Total participants2004-08-01118
Number of participants with account balances2004-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2004-08-010
2003: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2003 401k membership
Total participants, beginning-of-year2003-08-010
Total number of active participants reported on line 7a of the Form 55002003-08-01118
Number of retired or separated participants receiving benefits2003-08-010
Number of other retired or separated participants entitled to future benefits2003-08-010
Total of all active and inactive participants2003-08-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2003-08-010
Total participants2003-08-01118
Number of participants with account balances2003-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2003-08-010

Form 5500 Responses for FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN

2019: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes
2006: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2006 form 5500 responses
2006-08-01Type of plan entitySingle employer plan
2006-08-01Submission has been amendedNo
2006-08-01This submission is the final filingNo
2006-08-01This return/report is a short plan year return/report (less than 12 months)No
2006-08-01Plan is a collectively bargained planNo
2006-08-01Plan funding arrangement – InsuranceYes
2006-08-01Plan benefit arrangement – InsuranceYes
2005: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2005 form 5500 responses
2005-08-01Type of plan entitySingle employer plan
2005-08-01Submission has been amendedNo
2005-08-01This submission is the final filingNo
2005-08-01This return/report is a short plan year return/report (less than 12 months)No
2005-08-01Plan is a collectively bargained planNo
2005-08-01Plan funding arrangement – InsuranceYes
2005-08-01Plan benefit arrangement – InsuranceYes
2004: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2004 form 5500 responses
2004-08-01Type of plan entitySingle employer plan
2004-08-01Submission has been amendedNo
2004-08-01This submission is the final filingNo
2004-08-01This return/report is a short plan year return/report (less than 12 months)No
2004-08-01Plan is a collectively bargained planNo
2004-08-01Plan funding arrangement – InsuranceYes
2004-08-01Plan benefit arrangement – InsuranceYes
2003: FOUR SEASONS SALES & SERVICES, INC. INSURANCE PLAN 2003 form 5500 responses
2003-08-01Type of plan entitySingle employer plan
2003-08-01Submission has been amendedNo
2003-08-01This submission is the final filingNo
2003-08-01This return/report is a short plan year return/report (less than 12 months)No
2003-08-01Plan is a collectively bargained planNo
2003-08-01Plan funding arrangement – InsuranceYes
2003-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4366365
Policy instance 4
Insurance contract or identification numberE4366365
Number of Individuals Covered28
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,128
Total amount of fees paid to insurance companyUSD $126
Other welfare benefits providedCANCER, MED BRIDGE, ETC
Welfare Benefit Premiums Paid to CarrierUSD $13,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,678
Amount paid for insurance broker fees36
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10157411001
Policy instance 1
Insurance contract or identification number10157411001
Number of Individuals Covered134
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,555
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,555
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246032
Policy instance 2
Insurance contract or identification number246032
Number of Individuals Covered71
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $12,451
Total amount of fees paid to insurance companyUSD $1,497
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $72,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,451
Insurance broker organization code?3
Amount paid for insurance broker fees249
Additional information about fees paid to insurance brokerBONUS
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 3
Insurance contract or identification number96756
Number of Individuals Covered142
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,045
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,045
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10157411001
Policy instance 1
Insurance contract or identification number10157411001
Number of Individuals Covered153
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,465
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,465
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246032
Policy instance 2
Insurance contract or identification number246032
Number of Individuals Covered116
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $12,191
Total amount of fees paid to insurance companyUSD $253
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $71,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,191
Insurance broker organization code?3
Amount paid for insurance broker fees253
Additional information about fees paid to insurance brokerBONUS
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 3
Insurance contract or identification number96756
Number of Individuals Covered168
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,226
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,226
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4366365
Policy instance 4
Insurance contract or identification numberE4366365
Number of Individuals Covered28
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,221
Total amount of fees paid to insurance companyUSD $136
Other welfare benefits providedCANCER, MED BRIDGE, ETC
Welfare Benefit Premiums Paid to CarrierUSD $16,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,766
Amount paid for insurance broker fees38
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246032
Policy instance 2
Insurance contract or identification number246032
Number of Individuals Covered115
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $12,792
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $68,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,773
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 1
Insurance contract or identification number12264555
Number of Individuals Covered79
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $853
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $634
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4366365
Policy instance 4
Insurance contract or identification numberE4366365
Number of Individuals Covered26
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,392
Total amount of fees paid to insurance companyUSD $130
Other welfare benefits providedCANCER, MED BRIDGE, ETC
Welfare Benefit Premiums Paid to CarrierUSD $15,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,270
Amount paid for insurance broker fees3
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameCATHY M LERMAN
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 3
Insurance contract or identification number96756
Number of Individuals Covered156
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,761
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,761
Insurance broker organization code?3
Insurance broker nameP BRYNE WISEMAN
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4366365
Policy instance 4
Insurance contract or identification numberE4366365
Number of Individuals Covered50
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $19,323
Total amount of fees paid to insurance companyUSD $2,046
Other welfare benefits providedCANCER, MED BRIDGE, ETC
Welfare Benefit Premiums Paid to CarrierUSD $28,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,223
Amount paid for insurance broker fees375
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameTIMOTHY COBB
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 3
Insurance contract or identification number96756
Number of Individuals Covered188
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $34,745
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,745
Insurance broker organization code?3
Insurance broker nameP BRYNE WISEMAN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 1
Insurance contract or identification number12264555
Number of Individuals Covered93
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $921
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $921
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered109
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,559
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $73,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,559
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 5
Insurance contract or identification number96756
Number of Individuals Covered169
Insurance policy start date2015-08-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $852
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $852
Insurance broker organization code?3
Insurance broker nameP BRYNE WISEMAN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 3
Insurance contract or identification number12264555
Number of Individuals Covered104
Insurance policy start date2013-09-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $1,144
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,144
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 1
Insurance contract or identification number12264555
Number of Individuals Covered107
Insurance policy start date2014-10-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $316
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $316
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered110
Insurance policy start date2014-08-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,388
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $31,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,388
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 3
Insurance contract or identification number12264555
Number of Individuals Covered120
Insurance policy start date2012-09-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $1,254
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,254
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered132
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $13,938
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $80,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,938
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 1
Insurance contract or identification number96756
Number of Individuals Covered216
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $54,837
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,837
Insurance broker organization code?3
Insurance broker nameP BRYNE WISEMAN
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 1
Insurance contract or identification number96756
Number of Individuals Covered252
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $58,595
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,595
Insurance broker organization code?3
Insurance broker nameP BRYNE WISEMAN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 3
Insurance contract or identification number12264555
Number of Individuals Covered127
Insurance policy start date2011-09-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,291
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,291
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered148
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $14,931
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $86,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,931
Insurance broker organization code?3
Insurance broker nameINSURANCE SPECIALISTS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 3
Insurance contract or identification number12264555
Number of Individuals Covered127
Insurance policy start date2010-09-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $1,225
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered152
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $14,425
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $83,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 1
Insurance contract or identification number96756
Number of Individuals Covered253
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $46,274
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number057-6369-00
Policy instance 2
Insurance contract or identification number057-6369-00
Number of Individuals Covered150
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $13,633
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $78,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number96756
Policy instance 1
Insurance contract or identification number96756
Number of Individuals Covered249
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $42,662
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12264555
Policy instance 3
Insurance contract or identification number12264555
Number of Individuals Covered133
Insurance policy start date2009-09-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $1,243
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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