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KENNESAW MOTOR SALES,INC BENEFIT PLAN 401k Plan overview

Plan NameKENNESAW MOTOR SALES,INC BENEFIT PLAN
Plan identification number 501

KENNESAW MOTOR SALES,INC BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover

401k Sponsoring company profile

KENNESAW MOTOR SALES, INC. has sponsored the creation of one or more 401k plans.

Company Name:KENNESAW MOTOR SALES, INC.
Employer identification number (EIN):650234141
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KENNESAW MOTOR SALES,INC BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01JAMES O. PERRIN
5012016-01-01JAMES O. PERRIN
5012015-01-01JAMES O. PERRIN
5012014-01-01JAMES O. PERRIN
5012013-01-01JAMES O. PERRIN

Plan Statistics for KENNESAW MOTOR SALES,INC BENEFIT PLAN

401k plan membership statisitcs for KENNESAW MOTOR SALES,INC BENEFIT PLAN

Measure Date Value
2022: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01178
Total number of active participants reported on line 7a of the Form 55002022-01-01185
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01185
2021: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01178
Total number of active participants reported on line 7a of the Form 55002021-01-01178
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 participants2021-01-01178
2020: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01192
Total number of active participants reported on line 7a of the Form 55002020-01-01178
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 participants2020-01-01178
2019: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01197
Total number of active participants reported on line 7a of the Form 55002019-01-01192
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 participants2019-01-01192
2018: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01173
Total number of active participants reported on line 7a of the Form 55002018-01-01197
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 participants2018-01-01197
2017: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01165
Total number of active participants reported on line 7a of the Form 55002017-01-01173
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 participants2017-01-01173
2016: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01142
Total number of active participants reported on line 7a of the Form 55002016-01-01165
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 participants2016-01-01165
2015: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01142
Total number of active participants reported on line 7a of the Form 55002015-01-01142
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 participants2015-01-01142
2014: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01130
Total number of active participants reported on line 7a of the Form 55002014-01-01142
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 participants2014-01-01142
2013: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-010
Total number of active participants reported on line 7a of the Form 55002013-01-01130
Total of all active and inactive participants2013-01-01130

Financial Data on KENNESAW MOTOR SALES,INC BENEFIT PLAN

Measure Date Value
2022 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-12-31$0
Total plan assets at end of year2022-12-31$0
Total plan assets at beginning of year2022-12-31$0
Net plan assets at end of year (total assets less liabilities)2022-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$0
2021 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-12-31$0
Total plan assets at end of year2021-12-31$0
Total plan assets at beginning of year2021-12-31$0
Net plan assets at end of year (total assets less liabilities)2021-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$0
2020 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-12-31$0
Total plan assets at end of year2020-12-31$0
Total plan assets at beginning of year2020-12-31$0
Net plan assets at end of year (total assets less liabilities)2020-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$0
2019 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2019 401k financial data
Total income from all sources2019-12-31$0
Total plan assets at end of year2019-12-31$0
Total plan assets at beginning of year2019-12-31$0
Net plan assets at end of year (total assets less liabilities)2019-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$0
2018 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-12-31$0
Total plan assets at end of year2018-12-31$0
Total plan assets at beginning of year2018-12-31$0
Net plan assets at end of year (total assets less liabilities)2018-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$0
2017 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-12-31$0
Total plan assets at end of year2017-12-31$0
Total plan assets at beginning of year2017-12-31$0
Net plan assets at end of year (total assets less liabilities)2017-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$0
2016 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2016 401k financial data
Total income from all sources2016-12-31$0
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$0
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
2015 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-12-31$0
Total plan assets at end of year2015-12-31$0
Total plan assets at beginning of year2015-12-31$0
Net plan assets at end of year (total assets less liabilities)2015-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$0
2014 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2014 401k financial data
Total income from all sources2014-12-31$0
Total plan assets at end of year2014-12-31$0
Total plan assets at beginning of year2014-12-31$0
Net plan assets at end of year (total assets less liabilities)2014-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
2013 : KENNESAW MOTOR SALES,INC BENEFIT PLAN 2013 401k financial data
Total income from all sources2013-12-31$0
Total plan assets at end of year2013-12-31$0
Total plan assets at beginning of year2013-12-31$0
Net plan assets at end of year (total assets less liabilities)2013-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0

Form 5500 Responses for KENNESAW MOTOR SALES,INC BENEFIT PLAN

2022: KENNESAW MOTOR SALES,INC BENEFIT 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC 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: KENNESAW MOTOR SALES,INC BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL/VISION
Policy instance 3
Insurance contract or identification numberDENTAL/VISION
Number of Individuals Covered178
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $177,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered176
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $74,756
Welfare Benefit Premiums Paid to CarrierUSD $2,293,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,756
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered181
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,137
Welfare Benefit Premiums Paid to CarrierUSD $143,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,137
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL/VISION
Policy instance 3
Insurance contract or identification numberDENTAL/VISION
Number of Individuals Covered178
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $162,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered176
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $89,559
Welfare Benefit Premiums Paid to CarrierUSD $2,798,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,559
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered173
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $20,634
Welfare Benefit Premiums Paid to CarrierUSD $144,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,634
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered176
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $20,410
Welfare Benefit Premiums Paid to CarrierUSD $58,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,410
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered178
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $89,028
Welfare Benefit Premiums Paid to CarrierUSD $2,556,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,028
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL/VISION
Policy instance 3
Insurance contract or identification numberDENTAL/VISION
Number of Individuals Covered178
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $132,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL/VISION
Policy instance 3
Insurance contract or identification numberDENTAL/VISION
Number of Individuals Covered182
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $179,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered197
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $98,204
Welfare Benefit Premiums Paid to CarrierUSD $2,662,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98,204
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered194
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $17,516
Welfare Benefit Premiums Paid to CarrierUSD $58,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,516
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL
Policy instance 3
Insurance contract or identification numberDENTAL
Number of Individuals Covered167
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Welfare Benefit Premiums Paid to CarrierUSD $141,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered173
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Welfare Benefit Premiums Paid to CarrierUSD $1,913,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered167
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Welfare Benefit Premiums Paid to CarrierUSD $39,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL
Policy instance 3
Insurance contract or identification numberDENTAL
Number of Individuals Covered148
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Welfare Benefit Premiums Paid to CarrierUSD $102,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered151
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Welfare Benefit Premiums Paid to CarrierUSD $1,321,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered116
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Welfare Benefit Premiums Paid to CarrierUSD $58,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered104
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,109
Welfare Benefit Premiums Paid to CarrierUSD $67,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,109
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered142
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $64,939
Welfare Benefit Premiums Paid to CarrierUSD $1,433,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,939
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL
Policy instance 3
Insurance contract or identification numberDENTAL
Number of Individuals Covered140
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Welfare Benefit Premiums Paid to CarrierUSD $110,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberDENTAL
Policy instance 3
Insurance contract or identification numberDENTAL
Number of Individuals Covered53
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberHEALTH HMO
Policy instance 2
Insurance contract or identification numberHEALTH HMO
Number of Individuals Covered134
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $60,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,923
Additional information about fees paid to insurance brokerHEALTH HMO
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number
Policy instance 1
Number of Individuals Covered78
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,162
Additional information about fees paid to insurance brokerLTD LIFE INSURANCE
Insurance broker organization code?3
Insurance broker nameJAMES T. MCNICHOLS

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