THLOPTHLOCCO TRIBAL TOWN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THLOPTHLOCCO TRIBAL TOWN SEC 125 PREMIUM ONLY PLAN
401k plan membership statisitcs for THLOPTHLOCCO TRIBAL TOWN SEC 125 PREMIUM ONLY PLAN
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 12356000 |
Policy instance | 7 |
Insurance contract or identification number | 12356000 | Number of Individuals Covered | 73 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $8,126 | Total amount of fees paid to insurance company | USD $263 | Other welfare benefits provided | CRITIAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $46,749 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,126 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 263 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSION |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 253570 |
Policy instance | 1 |
Insurance contract or identification number | 253570 | Number of Individuals Covered | 140 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $37,043 | Total amount of fees paid to insurance company | USD $3,207 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $634,787 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1737 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $37,043 |
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LIBERTY NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65331 ) |
Policy contract number | 81018 |
Policy instance | 2 |
Insurance contract or identification number | 81018 | Number of Individuals Covered | 11 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $324 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $98 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 3 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 14 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $4,422 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $20,873 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,879 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADMIN FEES |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4322806 |
Policy instance | 4 |
Insurance contract or identification number | E4322806 | Number of Individuals Covered | 1 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $4 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $512 | 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 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30103730 |
Policy instance | 5 |
Insurance contract or identification number | 30103730 | Number of Individuals Covered | 100 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-05-31 | Total amount of commissions paid to insurance broker | USD $1,044 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,271 | 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 | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018228-00 |
Policy instance | 6 |
Insurance contract or identification number | 01-018228-00 | Number of Individuals Covered | 100 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $5,497 | Total amount of fees paid to insurance company | USD $-31 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $36,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | -31 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $-120 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 253570 |
Policy instance | 1 |
Insurance contract or identification number | 253570 | Number of Individuals Covered | 119 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-30 | Total amount of commissions paid to insurance broker | USD $37,657 | Total amount of fees paid to insurance company | USD $1,777 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $651,947 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,657 | Amount paid for insurance broker fees | 1777 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
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LIBERTY NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65331 ) |
Policy contract number | 81018 |
Policy instance | 2 |
Insurance contract or identification number | 81018 | Number of Individuals Covered | 9 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $594 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $155 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 3 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 15 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $2,083 | Total amount of fees paid to insurance company | USD $32 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $14,669 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,262 | Amount paid for insurance broker fees | 22 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4322806 |
Policy instance | 4 |
Insurance contract or identification number | E4322806 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $4 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $438 | 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 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30103730 |
Policy instance | 5 |
Insurance contract or identification number | 30103730 | Number of Individuals Covered | 96 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $1,180 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,835 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $712 | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018228-00 |
Policy instance | 6 |
Insurance contract or identification number | 01-018228-00 | Number of Individuals Covered | 100 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $7,089 | Total amount of fees paid to insurance company | USD $947 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $42,173 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 947 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $7,089 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 253570 |
Policy instance | 1 |
Insurance contract or identification number | 253570 | Number of Individuals Covered | 124 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $34,785 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $620,864 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,785 | Insurance broker organization code? | 3 |
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LIBERTY NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65331 ) |
Policy contract number | |
Policy instance | 2 |
Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 3 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 16 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $2,583 | Total amount of fees paid to insurance company | USD $79 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $18,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,528 | Amount paid for insurance broker fees | 56 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4322806 |
Policy instance | 4 |
Insurance contract or identification number | E4322806 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0158104 |
Policy instance | 5 |
Insurance contract or identification number | 0158104 | Number of Individuals Covered | 142 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $930 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $930 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0914298 |
Policy instance | 1 |
Insurance contract or identification number | 0914298 | Number of Individuals Covered | 144 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $4,137 | Total amount of fees paid to insurance company | USD $30,856 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $412,805 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,137 | Amount paid for insurance broker fees | 30856 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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LIBERTY NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65331 ) |
Policy contract number | |
Policy instance | 2 |
Number of Individuals Covered | 11 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $672 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,991 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $184 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 3 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 20 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $2,994 | Total amount of fees paid to insurance company | USD $160 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $19,433 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,633 | Amount paid for insurance broker fees | 68 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4322806 |
Policy instance | 4 |
Insurance contract or identification number | E4322806 | Number of Individuals Covered | 1 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $3 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $477 | 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 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30032617 |
Policy instance | 5 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 98 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $899 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,144 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $899 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0914298 |
Policy instance | 2 |
Insurance contract or identification number | 0914298 | Number of Individuals Covered | 143 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $4,712 | Total amount of fees paid to insurance company | USD $30,907 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $634,706 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,712 | Amount paid for insurance broker fees | 30907 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30032617 |
Policy instance | 7 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 36 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30032617 |
Policy instance | 6 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 65 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $893 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,491 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $893 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4322806 |
Policy instance | 5 |
Insurance contract or identification number | E4322806 | Number of Individuals Covered | 1 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $23 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 $19 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 4 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 20 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $3,174 | Total amount of fees paid to insurance company | USD $310 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $20,257 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,919 | Amount paid for insurance broker fees | 222 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 305046 |
Policy instance | 1 |
Insurance contract or identification number | 305046 | Number of Individuals Covered | 102 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $8,982 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $66,486 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,982 | Insurance broker organization code? | 3 |
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LIBERTY NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65331 ) |
Policy contract number | |
Policy instance | 3 |
Number of Individuals Covered | 11 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $761 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,262 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $210 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 191526 |
Policy instance | 5 |
Insurance contract or identification number | 191526 | Number of Individuals Covered | 112 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $37,920 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $676,358 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,920 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | CI 960445 |
Policy instance | 4 |
Insurance contract or identification number | CI 960445 | Number of Individuals Covered | 71 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $4,392 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $12,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,392 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICE |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 305046 |
Policy instance | 3 |
Insurance contract or identification number | 305046 | Number of Individuals Covered | 110 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $6,129 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,748 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,129 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30032617 |
Policy instance | 2 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 98 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $890 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,927 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $779 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 1 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 23 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $6,175 | Total amount of fees paid to insurance company | USD $463 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $26,062 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,050 | Amount paid for insurance broker fees | 331 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 | Insurance broker name | JARRELL PRENTICE |
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STATE FARM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69108 ) |
Policy contract number | B04-2404-5942 |
Policy instance | 2 |
Insurance contract or identification number | B04-2404-5942 | Number of Individuals Covered | 111 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $437 | Life 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 $437 | Insurance broker organization code? | 3 | Insurance broker name | MATT MCCOY |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-00 |
Policy instance | 3 |
Insurance contract or identification number | 4094-00 | Number of Individuals Covered | 29 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $733 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,009 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $733 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-01 |
Policy instance | 4 |
Insurance contract or identification number | 4094-01 | Number of Individuals Covered | 75 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,548 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,548 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 5 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 21 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $2,594 | Total amount of fees paid to insurance company | USD $160 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $11,547 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,702 | Amount paid for insurance broker fees | 76 | Additional information about fees paid to insurance broker | ADMIN | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL ARTHUR KIRK |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 30032617 |
Policy instance | 6 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 93 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $727 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,538 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $727 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY, INC. |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0869466 |
Policy instance | 7 |
Insurance contract or identification number | 0869466 | Number of Individuals Covered | 143 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $3,330 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,271 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,330 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INS |
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TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 ) |
Policy contract number | SM86504E |
Policy instance | 1 |
Insurance contract or identification number | SM86504E | Number of Individuals Covered | 92 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-04-01 | Total amount of commissions paid to insurance broker | USD $19,414 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $129,424 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,414 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INS |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 30032617 |
Policy instance | 6 |
Insurance contract or identification number | 30032617 | Number of Individuals Covered | 75 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $655 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,105 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $655 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY, INC. |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 5 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 12 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $2,229 | Total amount of fees paid to insurance company | USD $73 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $7,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,119 | Amount paid for insurance broker fees | 30 | Additional information about fees paid to insurance broker | ADMIN | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL KIRK |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-01 |
Policy instance | 4 |
Insurance contract or identification number | 4094-01 | Number of Individuals Covered | 72 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $1,676 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,676 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-00 |
Policy instance | 3 |
Insurance contract or identification number | 4094-00 | Number of Individuals Covered | 36 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $846 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,435 | 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 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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STATE FARM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69108 ) |
Policy contract number | B04-2404-5942 |
Policy instance | 2 |
Insurance contract or identification number | B04-2404-5942 | Number of Individuals Covered | 101 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $424 | Life 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 $424 | Insurance broker organization code? | 3 | Insurance broker name | MATT MCCOY |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | Y08981 |
Policy instance | 1 |
Insurance contract or identification number | Y08981 | Number of Individuals Covered | 67 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $20,488 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $377,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,488 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INS |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-00 |
Policy instance | 3 |
Insurance contract or identification number | 4094-00 | Number of Individuals Covered | 37 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $788 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $246 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | Y08981 |
Policy instance | 1 |
Insurance contract or identification number | Y08981 | Number of Individuals Covered | 54 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $14,962 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $281,123 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,962 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INS |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-01 |
Policy instance | 4 |
Insurance contract or identification number | 4094-01 | Number of Individuals Covered | 70 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $1,441 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,980 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $320 | Insurance broker organization code? | 3 | Insurance broker name | SCOTT MCCOY INSURANCE AGENCY INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BQU08 |
Policy instance | 5 |
Insurance contract or identification number | BQU08 | Number of Individuals Covered | 19 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $5,004 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $15,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,650 | Insurance broker organization code? | 3 | Insurance broker name | TRAVIS D HURT |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 6 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 10 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $1,260 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $6,743 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $719 | Insurance broker organization code? | 3 | Insurance broker name | JOHN A WILLIAMS COMPANY INC |
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STATE FARM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69108 ) |
Policy contract number | B04-2404-5942 |
Policy instance | 2 |
Insurance contract or identification number | B04-2404-5942 | Number of Individuals Covered | 103 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $420 | Life 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 $420 | Insurance broker organization code? | 3 | Insurance broker name | MATT MCCOY |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BQU08 |
Policy instance | 5 |
Insurance contract or identification number | BQU08 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $1,624 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $3,683 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,178 | Insurance broker organization code? | 3 | Insurance broker name | TRAVIS D HURT |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-01 |
Policy instance | 4 |
Insurance contract or identification number | 4094-01 | Number of Individuals Covered | 68 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $1,534 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $12,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,534 | Insurance broker organization code? | 3 | Insurance broker name | BANCFIRST INSURANCE SERVICES INC |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-00 |
Policy instance | 3 |
Insurance contract or identification number | 4094-00 | Number of Individuals Covered | 34 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $728 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,871 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $728 | Insurance broker organization code? | 3 | Insurance broker name | BANCFIRST INSURANCE SERVICES INC |
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STATE FARM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69108 ) |
Policy contract number | B04-2404-5942 |
Policy instance | 2 |
Insurance contract or identification number | B04-2404-5942 | Number of Individuals Covered | 98 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $412 | Life 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 $412 | Insurance broker organization code? | 3 | Insurance broker name | MATT MCCOY |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 6 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 16 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $1,268 | Total amount of fees paid to insurance company | USD $140 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $3,349 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $900 | Amount paid for insurance broker fees | 88 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 | Insurance broker name | TRAVIS D HURT |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | Y08981 |
Policy instance | 1 |
Insurance contract or identification number | Y08981 | Number of Individuals Covered | 86 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $26,738 | Total amount of fees paid to insurance company | USD $800 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $251,902 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,738 | Amount paid for insurance broker fees | 800 | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | Insurance broker organization code? | 3 | Insurance broker name | BANCFIRST INSURANCE SERVICES INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BMW11 |
Policy instance | 6 |
Insurance contract or identification number | BMW11 | Number of Individuals Covered | 14 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $1,498 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $5,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | BQU08 |
Policy instance | 5 |
Insurance contract or identification number | BQU08 | Number of Individuals Covered | 22 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $2,884 | Total amount of fees paid to insurance company | USD $41 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CANCER, SPECIAL EVENT | Welfare Benefit Premiums Paid to Carrier | USD $10,900 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-01 |
Policy instance | 4 |
Insurance contract or identification number | 4094-01 | Number of Individuals Covered | 90 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $155 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $13,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | 4094-00 |
Policy instance | 3 |
Insurance contract or identification number | 4094-00 | Number of Individuals Covered | 38 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $59 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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STATE FARM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69108 ) |
Policy contract number | B04-2404-5942 |
Policy instance | 2 |
Insurance contract or identification number | B04-2404-5942 | Number of Individuals Covered | 113 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $419 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | Y08981 |
Policy instance | 1 |
Insurance contract or identification number | Y08981 | Number of Individuals Covered | 46 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $5,085 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $270,583 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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