PERFORMANCE CONTRACTORS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PERFORMANCE CONTRACTORS, INC HEALTH BENEFIT TRUST
401k plan membership statisitcs for PERFORMANCE CONTRACTORS, INC HEALTH BENEFIT TRUST
| Measure | Date | Value |
|---|
| 2022 : PERFORMANCE CONTRACTORS, INC HEALTH BENEFIT TRUST 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $2,139,673 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $1,515,952 |
| Total income from all sources (including contributions) | 2022-12-31 | $25,570,051 |
| Total of all expenses incurred | 2022-12-31 | $25,187,195 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $23,955,960 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $25,570,051 |
| Value of total assets at end of year | 2022-12-31 | $3,450,987 |
| Value of total assets at beginning of year | 2022-12-31 | $2,444,410 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,231,235 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $14,952,547 |
| Participant contributions at end of year | 2022-12-31 | $278,805 |
| Participant contributions at beginning of year | 2022-12-31 | $276,649 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $940,364 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $859,247 |
| Administrative expenses (other) incurred | 2022-12-31 | $7,249 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $158,256 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $149,773 |
| Total non interest bearing cash at end of year | 2022-12-31 | $646,147 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $101,211 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $382,856 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $1,311,314 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $928,458 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $3,137,175 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $10,617,504 |
| Employer contributions (assets) at end of year | 2022-12-31 | $1,585,671 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $1,207,303 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $20,818,785 |
| Contract administrator fees | 2022-12-31 | $1,223,986 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $1,981,417 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $1,366,179 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | MADDOX & ASSOCIATES APC |
| Accountancy firm EIN | 2022-12-31 | 721314069 |
| 2021 : PERFORMANCE CONTRACTORS, INC HEALTH BENEFIT TRUST 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,515,952 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,290,818 |
| Total income from all sources (including contributions) | 2021-12-31 | $23,913,397 |
| Total of all expenses incurred | 2021-12-31 | $23,679,520 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $22,681,884 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $23,913,397 |
| Value of total assets at end of year | 2021-12-31 | $2,444,410 |
| Value of total assets at beginning of year | 2021-12-31 | $1,985,399 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $997,636 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $11,961,122 |
| Participant contributions at end of year | 2021-12-31 | $276,649 |
| Participant contributions at beginning of year | 2021-12-31 | $393,205 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $859,247 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $572,969 |
| Administrative expenses (other) incurred | 2021-12-31 | $9,869 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $149,773 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $997 |
| Total non interest bearing cash at end of year | 2021-12-31 | $101,211 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $427,394 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $233,877 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $928,458 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $694,581 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $2,491,232 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $11,952,275 |
| Employer contributions (assets) at end of year | 2021-12-31 | $1,207,303 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $591,831 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $20,190,652 |
| Contract administrator fees | 2021-12-31 | $987,767 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $1,366,179 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $1,289,821 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | MADDOX & ASSOCIATES APC |
| Accountancy firm EIN | 2021-12-31 | 721314069 |
| 2020 : PERFORMANCE CONTRACTORS, INC HEALTH BENEFIT TRUST 2020 401k financial data |
|---|
| Total transfer of assets to this plan | 2020-12-31 | $2,137,771 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $1,290,818 |
| Total income from all sources (including contributions) | 2020-12-31 | $27,720,172 |
| Total of all expenses incurred | 2020-12-31 | $29,163,362 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $27,940,150 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $27,720,172 |
| Value of total assets at end of year | 2020-12-31 | $1,985,399 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,223,212 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $15,102,033 |
| Participant contributions at end of year | 2020-12-31 | $393,205 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $572,969 |
| Administrative expenses (other) incurred | 2020-12-31 | $10,908 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $997 |
| Total non interest bearing cash at end of year | 2020-12-31 | $427,394 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-1,443,190 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $694,581 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $3,237,312 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $12,618,139 |
| Employer contributions (assets) at end of year | 2020-12-31 | $591,831 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $24,702,838 |
| Contract administrator fees | 2020-12-31 | $1,212,304 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $1,289,821 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | MADDOX & ASSOCIATES APC |
| Accountancy firm EIN | 2020-12-31 | 721314069 |
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | PERF CONTRACT |
| Policy instance | 7 |
| Insurance contract or identification number | PERF CONTRACT | | Number of Individuals Covered | 4269 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-351027 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-351027 | | Number of Individuals Covered | 3264 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $18,907 | | Total amount of fees paid to insurance company | USD $5,187 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $189,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,907 | | Amount paid for insurance broker fees | 5187 | | Additional information about fees paid to insurance broker | NON-MONETARY COMP SUPP COMP/MARKETING FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0944J |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0944J | | Number of Individuals Covered | 2716 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,669 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,769 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000944J |
| Policy instance | 3 |
| Insurance contract or identification number | G000944J | | Number of Individuals Covered | 383 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $50,231 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $251,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,696 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 93378 |
| Policy instance | 4 |
| Insurance contract or identification number | 93378 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,465 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $9,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,134 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 15472 |
| Policy instance | 5 |
| Insurance contract or identification number | 15472 | | Number of Individuals Covered | 4152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $122,888 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,229,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $122,888 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-60868 99 |
| Policy instance | 6 |
| Insurance contract or identification number | 71-60868 99 | | Number of Individuals Covered | 4087 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $136,460 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $650,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $136,460 | | Additional information about fees paid to insurance broker | BLUE CROSS QUARTERLY BONUS PROGRAM | | Insurance broker organization code? | 3 |
|
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | PERF CONTRACT |
| Policy instance | 8 |
| Insurance contract or identification number | PERF CONTRACT | | Number of Individuals Covered | 4708 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-60868 99 |
| Policy instance | 7 |
| Insurance contract or identification number | 71-60868 99 | | Number of Individuals Covered | 4087 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $110,773 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $585,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $110,773 | | Additional information about fees paid to insurance broker | BLUE CROSS QUARTERLY BONUS PROGRAM | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 15472 |
| Policy instance | 6 |
| Insurance contract or identification number | 15472 | | Number of Individuals Covered | 3879 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $101,202 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $961,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $101,202 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0200366 |
| Policy instance | 5 |
| Insurance contract or identification number | 0200366 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,907 | | Total amount of fees paid to insurance company | USD $1,250 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,907 | | Amount paid for insurance broker fees | 1250 | | Additional information about fees paid to insurance broker | NON-MONETARY COMP SUPP COMP/MARKETING FEES | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 93378 |
| Policy instance | 4 |
| Insurance contract or identification number | 93378 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,675 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $11,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,254 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000944J |
| Policy instance | 3 |
| Insurance contract or identification number | G000944J | | Number of Individuals Covered | 390 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $46,440 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $232,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,474 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0944J |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0944J | | Number of Individuals Covered | 2508 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $28,641 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,345 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-351027 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-351027 | | Number of Individuals Covered | 2926 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,273 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,273 | | Additional information about fees paid to insurance broker | NON-MONETARY COMP SUPP COMP/MARKETING FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0944J |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0944J | | Number of Individuals Covered | 2273 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $34,354 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $171,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,201 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000944J |
| Policy instance | 3 |
| Insurance contract or identification number | G000944J | | Number of Individuals Covered | 470 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $46,432 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $232,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,467 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 93378 |
| Policy instance | 4 |
| Insurance contract or identification number | 93378 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,056 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $15,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,595 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0200366 |
| Policy instance | 5 |
| Insurance contract or identification number | 0200366 | | Number of Individuals Covered | 2357 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $20,811 | | Total amount of fees paid to insurance company | USD $3,208 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $184,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,811 | | Amount paid for insurance broker fees | 3208 | | Additional information about fees paid to insurance broker | NON-MONETARY COMP SUPP COMP/MARKETING FEES | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 15472 |
| Policy instance | 6 |
| Insurance contract or identification number | 15472 | | Number of Individuals Covered | 3463 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $127,992 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,279,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $127,992 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-60868 99 |
| Policy instance | 7 |
| Insurance contract or identification number | 71-60868 99 | | Number of Individuals Covered | 3708 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $57,038 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $444,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,038 | | Additional information about fees paid to insurance broker | BLUE CROSS QUARTERLY BONUS PROGRAM | | Insurance broker organization code? | 3 |
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| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | 78F59ERC |
| Policy instance | 1 |
| Insurance contract or identification number | 78F59ERC | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $81,536 | | Total amount of fees paid to insurance company | USD $49,819 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $568,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,536 | | Amount paid for insurance broker fees | 49819 | | Additional information about fees paid to insurance broker | BLUE CROSS QUARTERLY BONUS PROGRAM | | Insurance broker organization code? | 3 |
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