BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN
401k plan membership statisitcs for BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 269 |
| Total of all active and inactive participants | 2022-02-01 | 269 |
| 2021: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 251 |
| Total of all active and inactive participants | 2021-02-01 | 251 |
| 2020: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 227 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 254 |
| Total of all active and inactive participants | 2020-02-01 | 254 |
| 2019: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 224 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 227 |
| Number of retired or separated participants receiving benefits | 2019-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
| Total of all active and inactive participants | 2019-02-01 | 227 |
| 2018: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 224 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 3 |
| Total of all active and inactive participants | 2018-02-01 | 230 |
| 2017: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 238 |
| Number of retired or separated participants receiving benefits | 2017-02-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 3 |
| Total of all active and inactive participants | 2017-02-01 | 248 |
| 2016: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 202 |
| Total of all active and inactive participants | 2016-02-01 | 202 |
| 2015: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 179 |
| Total of all active and inactive participants | 2015-02-01 | 179 |
| 2014: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 168 |
| Total of all active and inactive participants | 2014-02-01 | 168 |
| 2013: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 175 |
| Total of all active and inactive participants | 2013-02-01 | 175 |
| 2012: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 175 |
| Total of all active and inactive participants | 2012-02-01 | 175 |
| 2011: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 177 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 165 |
| Total of all active and inactive participants | 2011-02-01 | 165 |
| 2010: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 177 |
| Total of all active and inactive participants | 2010-02-01 | 177 |
| 2009: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 169 |
| Total of all active and inactive participants | 2009-02-01 | 169 |
| 2008: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-02-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-02-01 | 171 |
| Total of all active and inactive participants | 2008-02-01 | 171 |
| 2007: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-02-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-02-01 | 171 |
| Total of all active and inactive participants | 2007-02-01 | 171 |
| 2006: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-02-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-02-01 | 193 |
| Total of all active and inactive participants | 2006-02-01 | 193 |
| 2022: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Submission has been amended | No |
| 2022-02-01 | This submission is the final filing | No |
| 2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-02-01 | Plan is a collectively bargained plan | No |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Submission has been amended | No |
| 2021-02-01 | This submission is the final filing | No |
| 2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-02-01 | Plan is a collectively bargained plan | No |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Submission has been amended | No |
| 2020-02-01 | This submission is the final filing | No |
| 2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-02-01 | Plan is a collectively bargained plan | No |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Submission has been amended | No |
| 2019-02-01 | This submission is the final filing | No |
| 2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-02-01 | Plan is a collectively bargained plan | No |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Submission has been amended | No |
| 2018-02-01 | This submission is the final filing | No |
| 2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-02-01 | Plan is a collectively bargained plan | No |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | Yes |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2008 form 5500 responses |
|---|
| 2008-02-01 | Type of plan entity | Single employer plan |
| 2008-02-01 | Plan funding arrangement – Insurance | Yes |
| 2008-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2007 form 5500 responses |
|---|
| 2007-02-01 | Type of plan entity | Single employer plan |
| 2007-02-01 | Plan funding arrangement – Insurance | Yes |
| 2007-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, PC HEALTH PLAN 2006 form 5500 responses |
|---|
| 2006-02-01 | Type of plan entity | Single employer plan |
| 2006-02-01 | First time form 5500 has been submitted | Yes |
| 2006-02-01 | Plan funding arrangement – Insurance | Yes |
| 2006-02-01 | Plan benefit arrangement – Insurance | Yes |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 6 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $7,998 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,971 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 5 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $3,431 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,431 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 |
|
| RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 ) |
| Policy contract number | 12065 |
| Policy instance | 4 |
| Insurance contract or identification number | 12065 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $93,556 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GAP INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $406,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,945 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 1 | | Amount paid for insurance broker fees | 0 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0022848 |
| Policy instance | 3 |
| Insurance contract or identification number | 0022848 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 2 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $4,690 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,330 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 62073 |
| Policy instance | 1 |
| Insurance contract or identification number | 62073 | | Number of Individuals Covered | 288 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 4 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $2,872 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,476 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 5 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $2,655 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,655 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 6 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $5,711 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,945 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 62073 |
| Policy instance | 1 |
| Insurance contract or identification number | 62073 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $8,671 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,671 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 0022848 |
| Policy instance | 2 |
| Insurance contract or identification number | 0022848 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 ) |
| Policy contract number | 1391 |
| Policy instance | 3 |
| Insurance contract or identification number | 1391 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $80,129 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GAP INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $381,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,419 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 1 | | Amount paid for insurance broker fees | 0 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 1 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $2,574 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,402 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | G1053-182 |
| Policy instance | 2 |
| Insurance contract or identification number | G1053-182 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $79,970 | | Total amount of fees paid to insurance company | USD $52,809 | | Other welfare benefits provided | GAP INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $426,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,711 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 32909 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 3 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $2,147 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,147 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 62073 |
| Policy instance | 4 |
| Insurance contract or identification number | 62073 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $8,240 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,240 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 5 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $6,098 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,295 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 6 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 6 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,588 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,382 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 5 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,257 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,070 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 164183 |
| Policy instance | 4 |
| Insurance contract or identification number | 164183 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $4,766 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,272 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | G1053-182 |
| Policy instance | 3 |
| Insurance contract or identification number | G1053-182 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $86,276 | | Total amount of fees paid to insurance company | USD $56,501 | | Other welfare benefits provided | GAP INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $316,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,024 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 33355 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 2 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 62073 |
| Policy instance | 1 |
| Insurance contract or identification number | 62073 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $8,130 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE, DEPENDENT LIFE, VOLUNTARY AD&D, DEPENDENT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $90,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,130 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | 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 Carrier | USD $16,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 11524 |
| Policy instance | 2 |
| Insurance contract or identification number | 11524 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $95,262 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | HEALTH DEDUCTIBLE GAP COVERAGE | | 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 Carrier | USD $433,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,631 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN C KELLY |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 877397G |
| Policy instance | 3 |
| Insurance contract or identification number | 877397G | | Number of Individuals Covered | 65 | | Insurance policy start date | 2016-12-01 | | Insurance policy end date | 2017-11-30 | | Total amount of commissions paid to insurance broker | USD $8,348 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $51,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,174 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00519753 |
| Policy instance | 4 |
| Insurance contract or identification number | 00519753 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $1,038 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $8,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $519 | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 877397G |
| Policy instance | 5 |
| Insurance contract or identification number | 877397G | | Number of Individuals Covered | 66 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $1,444 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $13,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $722 | | Insurance broker organization code? | 3 | | Insurance broker name | LAKESHORE BENEFIT ALLIANCE LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00519753 |
| Policy instance | 6 |
| Insurance contract or identification number | 00519753 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2016-12-01 | | Insurance policy end date | 2017-11-30 | | Total amount of commissions paid to insurance broker | USD $5,994 | | Total amount of fees paid to insurance company | USD $3,062 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $48,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,997 | | Amount paid for insurance broker fees | 1786 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | HARMON DENNIS BRADSHAW INC |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED, EPS | | Welfare Benefit Premiums Paid to Carrier | USD $14,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2009-02-01 | | Insurance policy end date | 2010-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2008-02-01 | | Insurance policy end date | 2009-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2007-02-01 | | Insurance policy end date | 2008-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 22848 |
| Policy instance | 1 |
| Insurance contract or identification number | 22848 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2006-02-01 | | Insurance policy end date | 2007-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BABY YOURSELF, AIRMED | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
