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CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 401k Plan overview

Plan NameCARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN
Plan identification number 501

CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE 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
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CARE CENTERS MANAGEMENT CONSULTING, INC. has sponsored the creation of one or more 401k plans.

Company Name:CARE CENTERS MANAGEMENT CONSULTING, INC.
Employer identification number (EIN):621366831
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01EDITH CARMACK2023-07-20 ANITA WEST2023-07-20
5012021-01-01EDITH CARMACK2022-07-11 ANITA WEST2022-07-11
5012021-01-01
5012020-01-01CHERYL STEWART2021-07-13 ANITA WEST2021-07-13
5012019-01-01CHERYL STEWART2020-06-10 ANITA WEST2020-06-10
5012018-01-01
5012017-01-01
5012016-01-01
5012015-02-01
5012014-02-01
5012013-02-01
5012012-02-01
5012011-02-01
5012010-02-01
5012009-02-01
5012008-02-01
5012007-02-01
5012006-02-01

Plan Statistics for CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN

401k plan membership statisitcs for CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN

Measure Date Value
2022: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01326
Total number of active participants reported on line 7a of the Form 55002022-01-01334
Total of all active and inactive participants2022-01-01334
2021: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01636
Total number of active participants reported on line 7a of the Form 55002021-01-01326
Total of all active and inactive participants2021-01-01326
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-010
2020: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01382
Total number of active participants reported on line 7a of the Form 55002020-01-01636
Total of all active and inactive participants2020-01-01636
2019: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01333
Total number of active participants reported on line 7a of the Form 55002019-01-01382
Total of all active and inactive participants2019-01-01382
2018: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01377
Total number of active participants reported on line 7a of the Form 55002018-01-01333
Total of all active and inactive participants2018-01-01333
2017: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01377
Total number of active participants reported on line 7a of the Form 55002017-01-01377
Total of all active and inactive participants2017-01-01377
2016: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01528
Total number of active participants reported on line 7a of the Form 55002016-01-01377
Total of all active and inactive participants2016-01-01377
2015: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01528
Total number of active participants reported on line 7a of the Form 55002015-02-01528
Total of all active and inactive participants2015-02-01528
2014: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01529
Total number of active participants reported on line 7a of the Form 55002014-02-01528
Total of all active and inactive participants2014-02-01528
2013: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01458
Total number of active participants reported on line 7a of the Form 55002013-02-01529
Total of all active and inactive participants2013-02-01529
Total participants2013-02-01529
2012: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01410
Total number of active participants reported on line 7a of the Form 55002012-02-01458
Total of all active and inactive participants2012-02-01458
2011: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01404
Total number of active participants reported on line 7a of the Form 55002011-02-01410
Total of all active and inactive participants2011-02-01410
2010: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01368
Total number of active participants reported on line 7a of the Form 55002010-02-01404
Total of all active and inactive participants2010-02-01404
2009: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01387
Total number of active participants reported on line 7a of the Form 55002009-02-01368
Total of all active and inactive participants2009-02-01368
2008: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-02-01269
Total number of active participants reported on line 7a of the Form 55002008-02-01387
Total of all active and inactive participants2008-02-01387
2007: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-02-01260
Total number of active participants reported on line 7a of the Form 55002007-02-01269
Total of all active and inactive participants2007-02-01269
2006: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2006 401k membership
Total number of active participants reported on line 7a of the Form 55002006-02-01260
Total of all active and inactive participants2006-02-01260

Form 5500 Responses for CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN

2022: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2015 form 5500 responses
2015-02-01Type of plan entityMulitple employer plan
2015-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2014 form 5500 responses
2014-02-01Type of plan entityMulitple employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2013 form 5500 responses
2013-02-01Type of plan entityMulitple employer plan
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2012 form 5500 responses
2012-02-01Type of plan entityMulitple employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2011 form 5500 responses
2011-02-01Type of plan entityMulitple employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2010: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2010 form 5500 responses
2010-02-01Type of plan entityMulitple employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes
2009: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2009 form 5500 responses
2009-02-01Type of plan entityMulitple employer plan
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes
2008: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2008 form 5500 responses
2008-02-01Type of plan entityMulitple employer plan
2008-02-01Plan funding arrangement – InsuranceYes
2008-02-01Plan benefit arrangement – InsuranceYes
2007: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2007 form 5500 responses
2007-02-01Type of plan entityMulitple employer plan
2007-02-01Plan funding arrangement – InsuranceYes
2007-02-01Plan benefit arrangement – InsuranceYes
2006: CARE CENTERS MANAGEMENT CONSULTING, INC. WELFARE PLAN 2006 form 5500 responses
2006-02-01Type of plan entityMulitple employer plan
2006-02-01First time form 5500 has been submittedYes
2006-02-01Plan funding arrangement – InsuranceYes
2006-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered336
Insurance policy start date2022-05-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,355
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,355
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered376
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $73,939
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,939
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number0901
Policy instance 2
Insurance contract or identification number0901
Number of Individuals Covered216
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $27,752
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $185,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,752
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number65498
Policy instance 2
Insurance contract or identification number65498
Insurance policy start date2021-05-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $27,752
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,752
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered341
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $93,518
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93,518
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Amount paid for insurance broker fees0
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number65498
Policy instance 3
Insurance contract or identification number65498
Insurance policy start date2020-05-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $26,743
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $178,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,743
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number549802
Policy instance 2
Insurance contract or identification number549802
Number of Individuals Covered658
Insurance policy start date2020-01-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $12,464
Total amount of fees paid to insurance companyUSD $9,558
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,464
Amount paid for insurance broker fees9558
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered635
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $112,917
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $112,917
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number549802
Policy instance 2
Insurance contract or identification number549802
Number of Individuals Covered638
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $49,070
Total amount of fees paid to insurance companyUSD $11,167
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $385,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,070
Amount paid for insurance broker fees11167
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered444
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $83,856
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83,856
Additional information about fees paid to insurance brokerACQ / RET
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number549802
Policy instance 3
Insurance contract or identification number549802
Number of Individuals Covered471
Insurance policy start date2018-05-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $35,854
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $279,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,854
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017303-00
Policy instance 2
Insurance contract or identification number01-017303-00
Number of Individuals Covered432
Insurance policy start date2018-01-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $8,452
Total amount of fees paid to insurance companyUSD $2,294
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,353
Amount paid for insurance broker fees2294
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered458
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $72,524
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,524
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 2
Insurance contract or identification number103338
Number of Individuals Covered477
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $18,083
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,925
Additional information about fees paid to insurance brokerACT/RET
Insurance broker organization code?3
Insurance broker nameRICHARD SANGID
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number103338
Policy instance 1
Insurance contract or identification number103338
Number of Individuals Covered366
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $61,927
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,927
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
Insurance broker nameANDREW MANN

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