MAVERICK USA, INC. has sponsored the creation of one or more 401k plans.
Additional information about MAVERICK USA, INC.
Submission information for form 5500 for 401k plan WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC.
401k plan membership statisitcs for WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC.
| Measure | Date | Value |
|---|
| 2022: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 2,924 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 3,283 |
| Total of all active and inactive participants | 2022-01-01 | 3,283 |
| 2021: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 2,044 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 2,924 |
| Total of all active and inactive participants | 2021-01-01 | 2,924 |
| 2020: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 2,122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 2,044 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 2,044 |
| 2019: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 2,280 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 2,122 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 2,122 |
| 2018: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 2,050 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 2,280 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 2,280 |
| 2017: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 2,166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 2,050 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 2,050 |
| 2016: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 2,024 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 2,166 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 2,166 |
| 2015: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,804 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 2,024 |
| Total of all active and inactive participants | 2015-01-01 | 2,024 |
| Total participants | 2015-01-01 | 2,024 |
| 2014: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,777 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,804 |
| Total of all active and inactive participants | 2014-01-01 | 1,804 |
| Total participants | 2014-01-01 | 1,804 |
| 2013: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 1,780 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,777 |
| Total of all active and inactive participants | 2013-01-01 | 1,777 |
| Total participants | 2013-01-01 | 1,777 |
| 2012: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 1,493 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,780 |
| Total of all active and inactive participants | 2012-01-01 | 1,780 |
| Total participants | 2012-01-01 | 1,780 |
| 2011: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 1,384 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,493 |
| Total of all active and inactive participants | 2011-01-01 | 1,493 |
| Total participants | 2011-01-01 | 1,493 |
| 2010: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 1,295 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,384 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 1,384 |
| Total participants | 2010-01-01 | 1,384 |
| 2009: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 1,565 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,295 |
| Total of all active and inactive participants | 2009-01-01 | 1,295 |
| Total participants | 2009-01-01 | 1,295 |
| 2022: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3416 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $14,693 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $14,693 | | Insurance broker organization code? | 3 |
|
| SOUTHWEST EAP (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 2081 | | Insurance policy start date | 2021-12-19 | | Insurance policy end date | 2022-12-19 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $43,390 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 4 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 2000 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $380,463 | | Total amount of fees paid to insurance company | USD $34,858 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,536,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $380,463 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 30601 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 | | Number of Individuals Covered | 647 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $37,092 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $186,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,092 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 2 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1391 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $17,019 | | 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 $17,019 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 | | Number of Individuals Covered | 634 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $33,988 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $201,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,988 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 2 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1269 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $16,774 | | 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 $16,774 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 4 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1829 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $324,759 | | Total amount of fees paid to insurance company | USD $6,168 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,016,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $302,431 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6168 | | Additional information about fees paid to insurance broker | BONUS PAYMENT |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3086 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $14,792 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $14,792 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 4 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1327 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $17,468 | | 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 $17,468 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 3 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1891 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $341,191 | | Total amount of fees paid to insurance company | USD $26,597 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD; SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,409,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $341,191 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 23772 | | Additional information about fees paid to insurance broker | BONUS |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 |
| Policy instance | 2 |
| Insurance contract or identification number | 86785 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $53,124 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $262,657 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,124 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMP |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3270 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,408 | | Dental 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 $15,408 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3381 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $16,101 | | Dental 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 $16,101 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 |
| Policy instance | 2 |
| Insurance contract or identification number | 86785 | | Number of Individuals Covered | 697 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $55,289 | | Total amount of fees paid to insurance company | USD $850 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $201,717 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,289 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 850 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMP |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 3 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 2000 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $337,081 | | Total amount of fees paid to insurance company | USD $36,895 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD; SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,112,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $337,081 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 31698 | | Additional information about fees paid to insurance broker | BONUS |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 4 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1404 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $18,325 | | 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 $18,325 | | Insurance broker organization code? | 3 |
|
| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 247110 |
| Policy instance | 5 |
| Insurance contract or identification number | 247110 | | Number of Individuals Covered | 1998 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $51,359 | | Health 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 $51,359 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 |
| Policy instance | 2 |
| Insurance contract or identification number | 86785 | | Number of Individuals Covered | 567 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $44,432 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $197,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,432 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SVCS SOUTHWEST INC |
|
| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 247110 |
| Policy instance | 5 |
| Insurance contract or identification number | 247110 | | Number of Individuals Covered | 1915 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $48,738 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 48738 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES SOUTHWEST INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 4 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1293 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $17,144 | | 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 $17,144 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES SOUTHWEST, INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 3 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1921 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $297,490 | | Total amount of fees paid to insurance company | USD $6,872 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD; SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,791,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $268,746 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6872 | | Insurance broker name | AON RISK SERVICES CENTRAL INC. |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3213 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $15,406 | | Dental 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 $15,406 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES SOUTHWEST INC |
|
| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 247110 |
| Policy instance | 5 |
| Insurance contract or identification number | 247110 | | Number of Individuals Covered | 1840 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $36,198 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 36198 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES SOUTHWEST INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 4 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1247 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,376 | | 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 $15,376 | | Insurance broker name | AON RISK SERVICES OF SOUTHWEST, INC |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 86931 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $37,699 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $157,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,620 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP INSURANCE SERVICES |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 2 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1847 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $227,062 | | Total amount of fees paid to insurance company | USD $18,319 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,389,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $227,062 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14333 | | Insurance broker name | AON RISH SERVICES CENTRAL INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 3222 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $14,108 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $14,108 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, SOUTHWEST INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 4 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 1056 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $14,050 | | 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 | | 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 $14,050 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES OF SOUTHWEST, INC |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 86931 | | Number of Individuals Covered | 396 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $35,388 | | 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 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $151,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,302 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP INSURANCE SERVICES |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 2 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1646 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $176,560 | | Total amount of fees paid to insurance company | USD $17,540 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,280,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $176,560 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 17540 | | Insurance broker name | AON CONSULTING OF NEW JERSEY INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 2886 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $12,866 | | 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 | | Dental 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 $12,866 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, SOUTHWEST INC |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 86931 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $30,736 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $129,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,666 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD J CAZZELL |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 5 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 995 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,169 | | 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 | | 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 $13,169 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES OF SOUTHWEST, INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 709078 |
| Policy instance | 4 |
| Insurance contract or identification number | 709078 | | Number of Individuals Covered | 1284 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $337,753 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,012,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $273,620 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING,INC OF ARKANSAS |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 2885 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,715 | | 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 | | Dental 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 $11,715 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, SOUTHWEST INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 2 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1610 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $217,536 | | Total amount of fees paid to insurance company | USD $16,334 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,346,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $217,536 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16334 | | Insurance broker name | AON CONSULTING OF NEW JERSEY INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 2916 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $10,802 | | 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 | | Dental 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 $10,802 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, SOUTHWEST INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402314G |
| Policy instance | 2 |
| Insurance contract or identification number | 402314G | | Number of Individuals Covered | 1567 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $124,216 | | Total amount of fees paid to insurance company | USD $13,157 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $828,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $124,216 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13157 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | AON CONSULTING OF NEW JERSEY INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 5 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 953 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,574 | | 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 | | 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 $11,574 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, SOUTHWEST INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 709078 |
| Policy instance | 4 |
| Insurance contract or identification number | 709078 | | Number of Individuals Covered | 1284 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $828,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86785 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86785 86931 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $22,670 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $101,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,606 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD J CAZZELL |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86933 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86933 86931 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $17,720 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $99,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 7 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 761 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $12,632 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 147917 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 147917 | | Number of Individuals Covered | 1484 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $31,125 | | 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 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $207,496 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 205049 |
| Policy instance | 8 |
| Insurance contract or identification number | VAR 205049 | | Number of Individuals Covered | 815 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,760 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,399 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 709078 |
| Policy instance | 6 |
| Insurance contract or identification number | 709078 | | Number of Individuals Covered | 1097 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $42,983 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $446,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 161450 |
| Policy instance | 5 |
| Insurance contract or identification number | G 161450 | | Number of Individuals Covered | 670 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $19,854 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $132,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000009243 |
| Policy instance | 1 |
| Insurance contract or identification number | 000009243 | | Number of Individuals Covered | 2446 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,385 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 121514 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 121514 | | Number of Individuals Covered | 670 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $62,559 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $417,057 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86933 86931 |
| Policy instance | 3 |
| Insurance contract or identification number | 86933 86931 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $15,270 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $100,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,190 | | Insurance broker organization code? | 3 | | Insurance broker name | AF SMITH & ASSOCIATES |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-89044732301 |
| Policy instance | 5 |
| Insurance contract or identification number | GD3-89044732301 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $19,253 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $128,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,253 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30016531 |
| Policy instance | 7 |
| Insurance contract or identification number | 30016531 | | Number of Individuals Covered | 677 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $11,346 | | 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 | | 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 $9,428 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES INC OF ARKANSAS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 709078 |
| Policy instance | 6 |
| Insurance contract or identification number | 709078 | | Number of Individuals Covered | 995 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $26,299 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $263,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,281 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, INC. |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 9243 & SUBLOCS |
| Policy instance | 1 |
| Insurance contract or identification number | 9243 & SUBLOCS | | Number of Individuals Covered | 2318 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $8,559 | | 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 | | Dental 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 $8,559 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 113293 |
| Policy instance | 2 |
| Insurance contract or identification number | 113293 | | Number of Individuals Covered | 1840 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $28,343 | | Total amount of fees paid to insurance company | USD $3,470 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $190,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,343 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3470 | | Insurance broker name | AON CONSULTING INC. |
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| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-89044732301 |
| Policy instance | 4 |
| Insurance contract or identification number | GF3-89044732301 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $60,223 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $399,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,223 | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK SERVICES, INC. |
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