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THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 401k Plan overview

Plan NameTHE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY
Plan identification number 501

THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

T.H. ROGERS LUMBER COMPANY has sponsored the creation of one or more 401k plans.

Company Name:T.H. ROGERS LUMBER COMPANY
Employer identification number (EIN):730427910
NAIC Classification:444190
NAIC Description:Other Building Material Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01WHITNEY HILL2023-10-05
5012021-04-01
5012020-04-01
5012019-04-01
5012018-04-01
5012017-04-01HOGANTAYLOR LLP PREPARER
5012016-04-01HOGANTAYLOR LLP PREPARER
5012015-04-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2016-10-31
5012014-04-01HOGANTAYLOR LLP PREPARER
5012013-04-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2014-10-29
5012012-04-01WILLIAM G. LINDLEY WILLIAM G. LINDLEY2013-07-24
5012011-04-01WILLIAM G. LINDLEY WILLIAM G. LINDLEY2012-07-11
5012009-04-01WILLIAM G. LINDLEY WILLIAM G. LINDLEY2010-10-05

Plan Statistics for THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY

401k plan membership statisitcs for THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY

Measure Date Value
2022: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2022 401k membership
Total participants, beginning-of-year2022-04-01194
Total number of active participants reported on line 7a of the Form 55002022-04-01175
Number of retired or separated participants receiving benefits2022-04-0130
Total of all active and inactive participants2022-04-01205
2021: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2021 401k membership
Total participants, beginning-of-year2021-04-01196
Total number of active participants reported on line 7a of the Form 55002021-04-01171
Number of retired or separated participants receiving benefits2021-04-0125
Total of all active and inactive participants2021-04-01196
2020: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2020 401k membership
Total participants, beginning-of-year2020-04-01198
Total number of active participants reported on line 7a of the Form 55002020-04-01198
Total of all active and inactive participants2020-04-01198
2019: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2019 401k membership
Total participants, beginning-of-year2019-04-01196
Total number of active participants reported on line 7a of the Form 55002019-04-01196
Total of all active and inactive participants2019-04-01196
2018: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2018 401k membership
Total participants, beginning-of-year2018-04-01196
Total number of active participants reported on line 7a of the Form 55002018-04-01196
Total of all active and inactive participants2018-04-01196
2017: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2017 401k membership
Total participants, beginning-of-year2017-04-01174
Total number of active participants reported on line 7a of the Form 55002017-04-01176
Number of retired or separated participants receiving benefits2017-04-011
Total of all active and inactive participants2017-04-01177
Total participants2017-04-01177
2016: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2016 401k membership
Total participants, beginning-of-year2016-04-01163
Total number of active participants reported on line 7a of the Form 55002016-04-01172
Number of retired or separated participants receiving benefits2016-04-011
Total of all active and inactive participants2016-04-01173
Total participants2016-04-01173
2015: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2015 401k membership
Total participants, beginning-of-year2015-04-01171
Total number of active participants reported on line 7a of the Form 55002015-04-01163
Total of all active and inactive participants2015-04-01163
Total participants2015-04-01163
2014: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2014 401k membership
Total participants, beginning-of-year2014-04-01176
Total number of active participants reported on line 7a of the Form 55002014-04-01171
Total of all active and inactive participants2014-04-01171
Total participants2014-04-01171
2013: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2013 401k membership
Total participants, beginning-of-year2013-04-01145
Total number of active participants reported on line 7a of the Form 55002013-04-01176
Total of all active and inactive participants2013-04-01176
Total participants2013-04-01176
2012: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2012 401k membership
Total participants, beginning-of-year2012-04-01179
Total number of active participants reported on line 7a of the Form 55002012-04-01145
Total of all active and inactive participants2012-04-01145
Total participants2012-04-01145
2011: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2011 401k membership
Total participants, beginning-of-year2011-04-01180
Total number of active participants reported on line 7a of the Form 55002011-04-01179
Total of all active and inactive participants2011-04-01179
Total participants2011-04-01179
2009: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2009 401k membership
Total participants, beginning-of-year2009-04-01208
Total number of active participants reported on line 7a of the Form 55002009-04-01187
Total of all active and inactive participants2009-04-01187
Total participants2009-04-01187

Form 5500 Responses for THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY

2022: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: THE E.B.A.T. OF THE T.H. ROGERS LUMBER COMPANY 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered142
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $4,389
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $29,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,389
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered206
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $4,674
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,674
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered205
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $10,057
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $67,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,057
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered197
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $10,004
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,004
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered198
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $9,797
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $65,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,797
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 2
Insurance contract or identification number694900
Number of Individuals Covered407
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $104,545
Total amount of fees paid to insurance companyUSD $245
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $297,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $102,216
Amount paid for insurance broker fees245
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS / BONUS
Insurance broker organization code?3
Insurance broker namePREMIERSOURCE, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered196
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $9,222
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $61,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,222
Insurance broker organization code?3
Insurance broker nameRYAN BENEFITS, INC.
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 1
Insurance contract or identification number694900
Number of Individuals Covered388
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $63,501
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $234,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,451
Insurance broker organization code?3
Insurance broker namePREMIERSOURCE, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 2
Insurance contract or identification numberG000AL2W
Number of Individuals Covered184
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $8,784
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $58,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,784
Insurance broker organization code?3
Insurance broker nameRYAN BENEFITS, INC.
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 1
Insurance contract or identification number694900
Number of Individuals Covered426
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $58,976
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $215,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,283
Insurance broker organization code?3
Insurance broker namePREMIER SOURCE LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 2
Insurance contract or identification numberG000AL2W
Number of Individuals Covered193
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $9,403
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $62,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,403
Insurance broker organization code?3
Insurance broker nameRYAN BENEFITS, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered197
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $9,375
Total amount of fees paid to insurance companyUSD $3,112
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $62,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,329
Insurance broker organization code?3
Amount paid for insurance broker fees3112
Insurance broker nameRYAN BENEFITS INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 2
Insurance contract or identification number694900
Number of Individuals Covered435
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $46,932
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $166,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,780
Insurance broker organization code?3
Insurance broker nameRYAN BENEFITS INC.
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 2
Insurance contract or identification number694900
Number of Individuals Covered145
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $54,310
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,017
Insurance broker organization code?3
Insurance broker namePREMIER SOURCE LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AL2W
Policy instance 1
Insurance contract or identification numberG000AL2W
Number of Individuals Covered145
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $9,527
Total amount of fees paid to insurance companyUSD $1,252
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $63,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,527
Amount paid for insurance broker fees1252
Insurance broker organization code?3
Insurance broker nameRED RIVER BENEFITS, INC.
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 2
Insurance contract or identification number694900
Number of Individuals Covered179
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $54,832
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06592
Policy instance 1
Insurance contract or identification number06592
Number of Individuals Covered179
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $11,850
Total amount of fees paid to insurance companyUSD $58
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06592
Policy instance 1
Insurance contract or identification number06592
Number of Individuals Covered180
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $12,445
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,445
Insurance broker organization code?3
Insurance broker nameRED RIVER BENEFITS, INC.
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number694900
Policy instance 2
Insurance contract or identification number694900
Number of Individuals Covered180
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $47,693
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,693
Insurance broker organization code?3
Insurance broker nameRED RIVER BENEFITS, INC.

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