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SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan NameSOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number 501

SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI has sponsored the creation of one or more 401k plans.

Company Name:SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI
Employer identification number (EIN):640732376
NAIC Classification:238210
NAIC Description:Electrical Contractors and Other Wiring Installation Contractors

Additional information about SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1997-08-18
Company Identification Number: 0011657106
Legal Registered Office Address: PO BOX 320398

FLOWOOD
United States of America (USA)
39232

More information about SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01JOANN SPRAYBERRY2022-07-19
5012020-01-01JOANN SPRAYBERRY2021-06-24
5012019-01-01JOANN SPRAYBERRY2020-10-06
5012018-01-01JOANN SPRAYBERRY2020-04-09
5012017-01-01JOANN SPRAYBERRY2020-04-09
5012016-01-01JOANN SPRAYBERRY2020-04-09
5012015-01-01JOANN SPRAYBERRY2020-04-09
5012014-01-01JOANN SPRAYBERRY2020-04-09
5012013-01-01JOANN SPRAYBERRY2020-04-09
5012012-01-01JOANN SPRAYBERRY2020-04-09
5012011-01-01JOANN SPRAYBERRY2020-04-09
5012010-01-01JOANN SPRAYBERRY2020-04-09
5012009-01-01JOANN SPRAYBERRY2020-04-09
5012008-01-01JOANN SPRAYBERRY2020-04-09
5012007-01-01JOANN SPRAYBERRY2020-04-09

Plan Statistics for SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2021: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01984
Total number of active participants reported on line 7a of the Form 55002021-01-01601
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01601
Number of employers contributing to the scheme2021-01-010
2020: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01762
Total number of active participants reported on line 7a of the Form 55002020-01-01984
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01984
Number of employers contributing to the scheme2020-01-010
2019: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01221
Total number of active participants reported on line 7a of the Form 55002019-01-01762
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01762
Number of employers contributing to the scheme2019-01-010
2018: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01206
Total number of active participants reported on line 7a of the Form 55002018-01-01221
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01221
Number of employers contributing to the scheme2018-01-010
2017: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01176
Total number of active participants reported on line 7a of the Form 55002017-01-01206
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01206
Number of employers contributing to the scheme2017-01-010
2016: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01151
Total number of active participants reported on line 7a of the Form 55002016-01-01176
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01176
Number of employers contributing to the scheme2016-01-010
2015: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0182
Total number of active participants reported on line 7a of the Form 55002015-01-01151
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01151
Number of employers contributing to the scheme2015-01-010
2014: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0179
Total number of active participants reported on line 7a of the Form 55002014-01-0182
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0182
Number of employers contributing to the scheme2014-01-010
2013: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0170
Total number of active participants reported on line 7a of the Form 55002013-01-0179
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0179
Number of employers contributing to the scheme2013-01-010
2012: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0178
Total number of active participants reported on line 7a of the Form 55002012-01-0170
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0170
Number of employers contributing to the scheme2012-01-010
2011: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0187
Total number of active participants reported on line 7a of the Form 55002011-01-0178
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0178
Number of employers contributing to the scheme2011-01-010
2010: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01104
Total number of active participants reported on line 7a of the Form 55002010-01-0187
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0187
Number of employers contributing to the scheme2010-01-010
2009: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01119
Total number of active participants reported on line 7a of the Form 55002009-01-01104
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01104
Number of employers contributing to the scheme2009-01-010
2008: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01110
Total number of active participants reported on line 7a of the Form 55002008-01-01119
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-010
Total of all active and inactive participants2008-01-01119
Number of employers contributing to the scheme2008-01-010
2007: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01100
Total number of active participants reported on line 7a of the Form 55002007-01-01110
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-010
Total of all active and inactive participants2007-01-01110
Number of employers contributing to the scheme2007-01-010

Form 5500 Responses for SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN

2021: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT 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: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT 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: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT 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: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: SOUTHERN ELECTRIC CORPORATION OF MISSISSIPPI EMPLOYEE HEALTH BENEFIT PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01First time form 5500 has been submittedYes
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )
Policy contract numberLICG191051
Policy instance 2
Insurance contract or identification numberLICG191051
Number of Individuals Covered1220
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $76,845
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $439,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $76,845
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS & BLUE SHIELD OF MISSISSIPPI (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329 ET AL
Policy instance 1
Insurance contract or identification number17329 ET AL
Number of Individuals Covered1186
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $125,240
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $125,240
Amount paid for insurance broker fees0
Insurance broker organization code?3
GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )
Policy contract numberLICG191051
Policy instance 2
Insurance contract or identification numberLICG191051
Number of Individuals Covered1105
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $76,128
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $435,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $76,128
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329 ET AL
Policy instance 1
Insurance contract or identification number17329 ET AL
Number of Individuals Covered1032
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $109,700
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $109,700
Amount paid for insurance broker fees0
Insurance broker organization code?3
GULF GUARANTY EMPLOYEE BENEFIT SERVICES, INC (National Association of Insurance Commissioners NAIC id number: 77976 )
Policy contract numberLICG191051
Policy instance 2
Insurance contract or identification numberLICG191051
Number of Individuals Covered820
Insurance policy start date2019-08-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $27,146
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $27,146
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329, ET AL
Policy instance 1
Insurance contract or identification number17329, ET AL
Number of Individuals Covered775
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $77,981
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $77,981
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329, ET AL
Policy instance 1
Insurance contract or identification number17329, ET AL
Number of Individuals Covered519
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $72,723
Total amount of fees paid to insurance companyUSD $0
Health 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 $72,723
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329, ET AL
Policy instance 1
Insurance contract or identification number17329, ET AL
Number of Individuals Covered483
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $60,009
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number17329, ET AL
Policy instance 2
Insurance contract or identification number17329, ET AL
Number of Individuals Covered355
Insurance policy start date2015-08-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $18,427
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,427
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number609739
Policy instance 1
Insurance contract or identification number609739
Number of Individuals Covered255
Insurance policy start date2015-01-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $28,860
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $575,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,860
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number609739
Policy instance 1
Insurance contract or identification number609739
Number of Individuals Covered193
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $43,815
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $808,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,815
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number609739
Policy instance 1
Insurance contract or identification number609739
Number of Individuals Covered185
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $33,000
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $666,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,000
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number609739
Policy instance 2
Insurance contract or identification number609739
Number of Individuals Covered164
Insurance policy start date2012-08-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $12,262
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,262
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered167
Insurance policy start date2012-01-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $7,586
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $7,586
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered184
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,560
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $16,560
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered204
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $18,933
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,933
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered244
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $21,205
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $21,205
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered281
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $19,830
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $19,830
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract number0004337, ET AL
Policy instance 1
Insurance contract or identification number0004337, ET AL
Number of Individuals Covered259
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $18,451
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,451
Amount paid for insurance broker fees0
Insurance broker organization code?3

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