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HOME BANK HEALTH WRAP PLAN 401k Plan overview

Plan NameHOME BANK HEALTH WRAP PLAN
Plan identification number 505

HOME BANK HEALTH WRAP PLAN Benefits

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

401k Sponsoring company profile

HOME BANK has sponsored the creation of one or more 401k plans.

Company Name:HOME BANK
Employer identification number (EIN):720214660
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME BANK HEALTH WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01
5052021-01-01
5052020-01-01
5052019-01-01
5052018-01-01KRISTY TOUCHET
5052017-01-01KRISTY TOUCHET

Plan Statistics for HOME BANK HEALTH WRAP PLAN

401k plan membership statisitcs for HOME BANK HEALTH WRAP PLAN

Measure Date Value
2022: HOME BANK HEALTH WRAP PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01378
Total number of active participants reported on line 7a of the Form 55002022-01-01398
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01398
2021: HOME BANK HEALTH WRAP PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01377
Total number of active participants reported on line 7a of the Form 55002021-01-01378
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01378
2020: HOME BANK HEALTH WRAP PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01378
Total number of active participants reported on line 7a of the Form 55002020-01-01377
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01377
2019: HOME BANK HEALTH WRAP PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01365
Total number of active participants reported on line 7a of the Form 55002019-01-01378
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01378
2018: HOME BANK HEALTH WRAP PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01281
Total number of active participants reported on line 7a of the Form 55002018-01-01365
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01365
2017: HOME BANK HEALTH WRAP PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-01281
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01281

Form 5500 Responses for HOME BANK HEALTH WRAP PLAN

2022: HOME BANK HEALTH WRAP PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: HOME BANK HEALTH WRAP PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: HOME BANK HEALTH WRAP PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: HOME BANK HEALTH WRAP PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: HOME BANK HEALTH WRAP PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HOME BANK HEALTH WRAP PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000024892
Policy instance 6
Insurance contract or identification number0000024892
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $14,468
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $84,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,914
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number879643G
Policy instance 5
Insurance contract or identification number879643G
Number of Individuals Covered490
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $40,733
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $271,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,051
Insurance broker organization code?3
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 4
Insurance contract or identification numberS2395
Number of Individuals Covered401
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $402
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees208
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30028211
Policy instance 3
Insurance contract or identification number30028211
Number of Individuals Covered345
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $2,236
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1557
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered398
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $795,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered398
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $26,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered378
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $24,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered378
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $626,119
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: 39616 )
Policy contract number30028211
Policy instance 3
Insurance contract or identification number30028211
Number of Individuals Covered311
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $2,074
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2074
Insurance broker organization code?3
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 4
Insurance contract or identification numberS2395
Number of Individuals Covered367
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $316
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees316
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number879643G
Policy instance 5
Insurance contract or identification number879643G
Number of Individuals Covered420
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $32,775
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $218,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,775
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000024892
Policy instance 6
Insurance contract or identification number0000024892
Number of Individuals Covered173
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,884
Other welfare benefits providedAFLAC
Welfare Benefit Premiums Paid to CarrierUSD $129,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,290
PARTNERSMGU (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberS2395
Policy instance 6
Insurance contract or identification numberS2395
Number of Individuals Covered377
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $163
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 number879643G
Policy instance 5
Insurance contract or identification number879643G
Number of Individuals Covered425
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $33,129
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $216,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,129
Insurance broker organization code?3
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 4
Insurance contract or identification numberS2395
Number of Individuals Covered361
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $372
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees372
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30028211
Policy instance 3
Insurance contract or identification number30028211
Number of Individuals Covered298
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $2,047
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2047
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered377
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $650,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered377
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $24,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PARTNERSMGU (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberS2395
Policy instance 7
Insurance contract or identification numberS2395
Number of Individuals Covered378
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $505,490
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 number879643G
Policy instance 6
Insurance contract or identification number879643G
Number of Individuals Covered427
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $34,643
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $224,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,643
Insurance broker organization code?3
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 5
Insurance contract or identification numberS2395
Number of Individuals Covered359
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $414
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees414
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30028211
Policy instance 4
Insurance contract or identification number30028211
Number of Individuals Covered310
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $2,053
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2053
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31444
Policy instance 3
Insurance contract or identification numberHCL31444
Number of Individuals Covered378
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $-409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered378
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered378
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $24,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered365
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $23,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered365
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31444
Policy instance 3
Insurance contract or identification numberHCL31444
Number of Individuals Covered365
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $60,484
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $527,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,484
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30028211
Policy instance 4
Insurance contract or identification number30028211
Number of Individuals Covered288
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of fees paid to insurance companyUSD $2,038
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2038
Insurance broker organization code?3
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 5
Insurance contract or identification numberS2395
Number of Individuals Covered334
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of fees paid to insurance companyUSD $254
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees254
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number879643G
Policy instance 6
Insurance contract or identification number879643G
Number of Individuals Covered433
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $29,229
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $194,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,229
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number879643G
Policy instance 6
Insurance contract or identification number879643G
Number of Individuals Covered319
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $29,048
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $141,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,559
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
GILSBAR, INC. (National Association of Insurance Commissioners NAIC id number: 52421 )
Policy contract numberS2395
Policy instance 5
Insurance contract or identification numberS2395
Number of Individuals Covered262
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $80
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees80
Insurance broker organization code?3
Insurance broker nameREGIONS INSUARNCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30028211
Policy instance 4
Insurance contract or identification number30028211
Number of Individuals Covered213
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $994
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees994
Insurance broker organization code?3
Insurance broker nameDONALD R MASSAD APC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31444
Policy instance 3
Insurance contract or identification numberHCL31444
Number of Individuals Covered281
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $34,530
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,246
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberS2395
Policy instance 2
Insurance contract or identification numberS2395
Number of Individuals Covered281
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberS2395
Policy instance 1
Insurance contract or identification numberS2395
Number of Individuals Covered281
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedUTILIZATION REVIEW
Welfare Benefit Premiums Paid to CarrierUSD $18,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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