BUTTERFIELD TRAIL VILLAGE, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN
401k plan membership statisitcs for BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 173 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 173 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 178 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
| Total of all active and inactive participants | 2021-01-01 | 180 |
| Total participants | 2021-01-01 | 180 |
| 2020: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 184 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 2 |
| Total of all active and inactive participants | 2020-01-01 | 186 |
| 2019: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 169 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 2 |
| Total of all active and inactive participants | 2019-01-01 | 171 |
| 2018: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 122 |
| Total of all active and inactive participants | 2018-01-01 | 122 |
| 2017: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 114 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 115 |
| Total participants | 2017-01-01 | 115 |
| 2016: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1 |
| Total of all active and inactive participants | 2016-01-01 | 119 |
| Total participants | 2016-01-01 | 119 |
| 2015: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 103 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
| Total of all active and inactive participants | 2015-01-01 | 104 |
| Total participants | 2015-01-01 | 104 |
| 2014: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 96 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 5 |
| Total of all active and inactive participants | 2014-01-01 | 101 |
| Total participants | 2014-01-01 | 101 |
| 2013: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 106 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 3 |
| Total of all active and inactive participants | 2013-01-01 | 109 |
| Total participants | 2013-01-01 | 109 |
| 2012: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 142 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Total of all active and inactive participants | 2012-01-01 | 143 |
| Total participants | 2012-01-01 | 143 |
| 2011: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 144 |
| Total of all active and inactive participants | 2011-01-01 | 144 |
| Total participants | 2011-01-01 | 144 |
| 2010: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 154 |
| Total of all active and inactive participants | 2010-01-01 | 154 |
| Total participants | 2010-01-01 | 154 |
| 2009: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 147 |
| Total of all active and inactive participants | 2009-01-01 | 147 |
| Total participants | 2009-01-01 | 147 |
| 2008: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 141 |
| Total of all active and inactive participants | 2008-01-01 | 141 |
| Total participants | 2008-01-01 | 141 |
| 2007: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 132 |
| Total of all active and inactive participants | 2007-01-01 | 132 |
| Total participants | 2007-01-01 | 132 |
| 2022: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 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: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 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 benefit arrangement – Insurance | Yes |
| 2013: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 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 benefit arrangement – Insurance | Yes |
| 2012: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 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 benefit arrangement – Insurance | Yes |
| 2011: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 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 benefit arrangement – Insurance | Yes |
| 2009: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: BUTTERFIELD TRAIL VILLAGE, INC. WELFARE BENEFITS PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | First time form 5500 has been submitted | Yes |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5381575 |
| Policy instance | 4 |
| Insurance contract or identification number | 5381575 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $27,819 | | Total amount of fees paid to insurance company | USD $8,771 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT,HOSPITAL,CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $175,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,841 | | Amount paid for insurance broker fees | 5120 | | Additional information about fees paid to insurance broker | TPA ADMIN FEES | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4224044 |
| Policy instance | 3 |
| Insurance contract or identification number | E4224044 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $975 | | Total amount of fees paid to insurance company | USD $33 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,545 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $304 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 203678 |
| Policy instance | 2 |
| Insurance contract or identification number | 203678 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $164 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 4 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 920411 |
| Policy instance | 1 |
| Insurance contract or identification number | 920411 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $13,604 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $563,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 12004 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4224044 |
| Policy instance | 3 |
| Insurance contract or identification number | E4224044 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,815 | | Total amount of fees paid to insurance company | USD $1,867 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL CARE, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $66,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,252 | | Amount paid for insurance broker fees | 110 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5381575 |
| Policy instance | 2 |
| Insurance contract or identification number | 5381575 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $18,846 | | Total amount of fees paid to insurance company | USD $9,699 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $111,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,846 | | Amount paid for insurance broker fees | 4499 | | Additional information about fees paid to insurance broker | TPA ADMIN FEES | | Insurance broker organization code? | 5 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0920411 |
| Policy instance | 1 |
| Insurance contract or identification number | 0920411 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $20,047 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $592,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 20047 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0920411 |
| Policy instance | 3 |
| Insurance contract or identification number | 0920411 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $23,241 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $752,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 23241 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0148786 |
| Policy instance | 2 |
| Insurance contract or identification number | 0148786 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $6,612 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,357 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,576 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 889713G |
| Policy instance | 1 |
| Insurance contract or identification number | 889713G | | Number of Individuals Covered | 183 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,906 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $52,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,906 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 00003968V |
| Policy instance | 2 |
| Insurance contract or identification number | 00003968V | | Number of Individuals Covered | 173 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,189 | | 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 $1,189 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B957 |
| Policy instance | 1 |
| Insurance contract or identification number | G000B957 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $9,883 | | Total amount of fees paid to insurance company | USD $2,364 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $68,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,883 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2364 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028879 |
| Policy instance | 4 |
| Insurance contract or identification number | 028879 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | 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 | 000003968 |
| Policy instance | 3 |
| Insurance contract or identification number | 000003968 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,297 | | 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 $3,297 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000003968 |
| Policy instance | 2 |
| Insurance contract or identification number | 000003968 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,177 | | 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 $2,177 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028879 |
| Policy instance | 3 |
| Insurance contract or identification number | 028879 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $19,456 | | 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 $19,456 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05914254 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05914254 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,503 | | Total amount of fees paid to insurance company | USD $1,031 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $62,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,503 | | Amount paid for insurance broker fees | 1031 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05914254 |
| Policy instance | 3 |
| Insurance contract or identification number | KM05914254 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,179 | | Total amount of fees paid to insurance company | USD $976 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $53,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,179 | | Amount paid for insurance broker fees | 976 | | Additional information about fees paid to insurance broker | NON-MONETARY COMP, SUPPLEMENTAL COMP, ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000003968 |
| Policy instance | 2 |
| Insurance contract or identification number | 000003968 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | 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 | 0901838 |
| Policy instance | 1 |
| Insurance contract or identification number | 0901838 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $14,100 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $456,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 14100 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05914254 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05914254 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,280 | | Total amount of fees paid to insurance company | USD $973 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $56,322 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,280 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0901838 |
| Policy instance | 3 |
| Insurance contract or identification number | 0901838 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,562 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $438,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,562 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000003968 |
| Policy instance | 1 |
| Insurance contract or identification number | 000003968 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,769 | | 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 $1,769 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 4 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $14,622 | | 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 $14,622 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50003953 |
| Policy instance | 1 |
| Insurance contract or identification number | 50003953 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $552 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $12,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $188 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE COMPANY |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 2 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,481 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $58,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,072 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP BENEFITS OF ARKANSAS LLC |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 3 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $911 | | 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 $911 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50003953 |
| Policy instance | 2 |
| Insurance contract or identification number | 50003953 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $426 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $10,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $109 | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD WHITE |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 1 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,365 | | 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 $15,365 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 3 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,628 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,628 | | Insurance broker organization code? | 3 | | Insurance broker name | LINDELL J. HERRIMAN |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 4 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,002 | | 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 $1,002 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 3 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,054 | | 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 $1,054 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 4 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,486 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,363 | | Insurance broker organization code? | 3 | | Insurance broker name | LINDELL J. HERRIMAN |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50003953 |
| Policy instance | 2 |
| Insurance contract or identification number | 50003953 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $661 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $12,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $386 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE COMPANY |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 1 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $16,233 | | 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 $16,233 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 4 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,536 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,536 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSOCIATED INS SERVICES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 2 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,101 | | 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 $1,101 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 100164701 |
| Policy instance | 1 |
| Insurance contract or identification number | 100164701 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $566 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $13,315 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $375 | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY CAIN |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 3 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $16,137 | | 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 $16,137 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 100164701 |
| Policy instance | 1 |
| Insurance contract or identification number | 100164701 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $604 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $14,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $402 | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY CAIN |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 2 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $3,532 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSOCIATED INS SERVICES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 3 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $1,084 | | 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 $1,084 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 4 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $15,733 | | 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 $15,733 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 2 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $14,903 | | 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 $14,903 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 3 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $3,454 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSOCIATED INS SERVICES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 1 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $1,066 | | 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 $1,066 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028038 |
| Policy instance | 3 |
| Insurance contract or identification number | 028038 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $13,404 | | 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 $13,404 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00281995 |
| Policy instance | 1 |
| Insurance contract or identification number | 00281995 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $3,527 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,840 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSOCIATED INS SERVICES |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017480 |
| Policy instance | 2 |
| Insurance contract or identification number | 017480 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $1,002 | | 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 $1,002 | | Insurance broker organization code? | 3 | | Insurance broker name | WALKER BROTHERS INSURANCE |
|
