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FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 401k Plan overview

Plan NameFALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN
Plan identification number 503

FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN Benefits

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

401k Sponsoring company profile

FALLS COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:FALLS COMMUNITY HOSPITAL
Employer identification number (EIN):741471231
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01JESSICA FORD2023-10-02 JESSICA FORD2023-10-02
5032021-01-01JESSICA FORD2022-10-17 JESSICA FORD2022-10-17
5032020-01-01JESSICA FORD2021-10-11
5032019-01-01JESSICA FORD2020-10-13
5032018-01-01JEFFREY LYLE2019-10-11
5032017-01-01
5032017-01-01
5032016-01-01
5032015-01-01WILLIS REESE
5032014-01-01WILLIS REESE
5032014-01-01WILLIS REESE
5032013-01-01WILLIS REESE
5032012-01-01WILLIS REESE
5032011-01-01WILLIS REESE
5032010-01-01PEGGY POLSTER BENEFITS COORDINATOR
5032009-01-01PEGGY POLSTER BENEFITS COORDINATOR

Plan Statistics for FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN

401k plan membership statisitcs for FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN

Measure Date Value
2022: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0161
Total number of active participants reported on line 7a of the Form 55002022-01-0179
Total of all active and inactive participants2022-01-0179
Total participants2022-01-0179
2021: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0185
Total number of active participants reported on line 7a of the Form 55002021-01-0161
Total of all active and inactive participants2021-01-0161
Total participants2021-01-0161
2020: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0194
Total number of active participants reported on line 7a of the Form 55002020-01-0185
Total of all active and inactive participants2020-01-0185
Total participants2020-01-0185
2019: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01185
Total number of active participants reported on line 7a of the Form 55002019-01-0194
Total of all active and inactive participants2019-01-0194
Total participants2019-01-0194
2018: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01182
Total number of active participants reported on line 7a of the Form 55002018-01-01185
Total of all active and inactive participants2018-01-01185
Total participants2018-01-01185
2017: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01123
Total number of active participants reported on line 7a of the Form 55002017-01-01182
Total of all active and inactive participants2017-01-01182
Total participants2017-01-01182
2016: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01131
Total number of active participants reported on line 7a of the Form 55002016-01-01123
Total of all active and inactive participants2016-01-01123
Total participants2016-01-01123
2015: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01134
Total number of active participants reported on line 7a of the Form 55002015-01-01131
Total of all active and inactive participants2015-01-01131
Total participants2015-01-01131
2014: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01137
Total number of active participants reported on line 7a of the Form 55002014-01-01134
Total of all active and inactive participants2014-01-01134
Total participants2014-01-01134
2013: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0197
Total number of active participants reported on line 7a of the Form 55002013-01-01137
Total of all active and inactive participants2013-01-01137
Total participants2013-01-01137
2012: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01108
Total number of active participants reported on line 7a of the Form 55002012-01-0197
Total of all active and inactive participants2012-01-0197
Total participants2012-01-0197
2011: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01116
Total number of active participants reported on line 7a of the Form 55002011-01-01108
Total of all active and inactive participants2011-01-01108
Total participants2011-01-01108
2010: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01126
Total number of active participants reported on line 7a of the Form 55002010-01-01108
Total of all active and inactive participants2010-01-01108
Total participants2010-01-01108
2009: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01113
Total number of active participants reported on line 7a of the Form 55002009-01-01126
Total of all active and inactive participants2009-01-01126
Total participants2009-01-01126

Form 5500 Responses for FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN

2022: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: FALLS COMMUNITY HOSP & CLINIC SEC 125 PREMIUM ONLY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0C2JM
Policy instance 6
Insurance contract or identification numberGVTL0C2JM
Number of Individuals Covered42
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $4,228
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $20,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,228
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0C2JM
Policy instance 5
Insurance contract or identification numberGUPR0C2JM
Number of Individuals Covered26
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDB0C2JM
Policy instance 4
Insurance contract or identification numberGUDB0C2JM
Number of Individuals Covered45
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $2,855
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,855
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0C2JM
Policy instance 3
Insurance contract or identification numberGUC0C2JM
Number of Individuals Covered29
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $2,626
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,626
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C2JM
Policy instance 2
Insurance contract or identification numberGLUG0C2JM
Number of Individuals Covered79
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $176
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $176
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0C2JM
Policy instance 1
Insurance contract or identification numberGLLV0C2JM
Number of Individuals Covered36
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $703
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $703
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number226405
Policy instance 1
Insurance contract or identification number226405
Number of Individuals Covered61
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22,694
Total amount of fees paid to insurance companyUSD $558
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $481,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,043
Amount paid for insurance broker fees558
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00546725
Policy instance 2
Insurance contract or identification number00546725
Number of Individuals Covered54
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,239
Total amount of fees paid to insurance companyUSD $3,450
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $39,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,025
Insurance broker organization code?3
Amount paid for insurance broker fees3385
Additional information about fees paid to insurance brokerFEES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602143
Policy instance 3
Insurance contract or identification numberVDT602143
Number of Individuals Covered26
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $1,865
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,865
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00546725
Policy instance 2
Insurance contract or identification number00546725
Number of Individuals Covered61
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,957
Total amount of fees paid to insurance companyUSD $2,195
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $44,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,389
Insurance broker organization code?3
Amount paid for insurance broker fees2195
Additional information about fees paid to insurance brokerFEES
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number226405
Policy instance 1
Insurance contract or identification number226405
Number of Individuals Covered85
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $24,198
Total amount of fees paid to insurance companyUSD $630
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $441,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,198
Amount paid for insurance broker fees630
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602144
Policy instance 4
Insurance contract or identification numberVDT602144
Number of Individuals Covered15
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $540
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $540
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602144
Policy instance 4
Insurance contract or identification numberVDT602144
Number of Individuals Covered14
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $521
Total amount of fees paid to insurance companyUSD $19
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $521
Insurance broker organization code?3
Amount paid for insurance broker fees19
Additional information about fees paid to insurance brokerOVERRIDE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00546725
Policy instance 2
Insurance contract or identification number00546725
Number of Individuals Covered94
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,464
Total amount of fees paid to insurance companyUSD $1,270
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $79,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,161
Insurance broker organization code?3
Amount paid for insurance broker fees1270
Additional information about fees paid to insurance brokerFEES
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number226405
Policy instance 1
Insurance contract or identification number226405
Number of Individuals Covered87
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,631
Total amount of fees paid to insurance companyUSD $3,642
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $447,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,631
Amount paid for insurance broker fees3642
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602143
Policy instance 3
Insurance contract or identification numberVDT602143
Number of Individuals Covered24
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $1,662
Total amount of fees paid to insurance companyUSD $58
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,662
Insurance broker organization code?3
Amount paid for insurance broker fees58
Additional information about fees paid to insurance brokerOVERRIDE
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000024115
Policy instance 1
Insurance contract or identification number0000024115
Number of Individuals Covered48
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,364
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $9,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,182
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number226405
Policy instance 2
Insurance contract or identification number226405
Number of Individuals Covered99
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $27,068
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $554,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,846
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00546725
Policy instance 3
Insurance contract or identification number00546725
Number of Individuals Covered71
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,630
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,063
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM608686
Policy instance 4
Insurance contract or identification numberSGM608686
Number of Individuals Covered185
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,633
Total amount of fees paid to insurance companyUSD $1,032
Life Insurance Welfare BenefitYes
Other welfare benefits providedSUPP. LIFE, DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $16,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $607
Insurance broker organization code?3
Amount paid for insurance broker fees1032
Additional information about fees paid to insurance brokerOVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK606394
Policy instance 5
Insurance contract or identification numberSOK606394
Number of Individuals Covered185
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $160
Total amount of fees paid to insurance companyUSD $100
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60
Insurance broker organization code?3
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerOVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602143
Policy instance 6
Insurance contract or identification numberVDT602143
Number of Individuals Covered23
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $1,193
Total amount of fees paid to insurance companyUSD $825
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $430
Insurance broker organization code?3
Amount paid for insurance broker fees825
Additional information about fees paid to insurance brokerOVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602144
Policy instance 7
Insurance contract or identification numberVDT602144
Number of Individuals Covered15
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $383
Total amount of fees paid to insurance companyUSD $263
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $245
Amount paid for insurance broker fees263
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 2
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $141
Health Insurance Welfare BenefitYes
Other welfare benefits providedHEART/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $88
Insurance broker organization code?3
Insurance broker nameASPEN REINSURANCE GROUP, INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMG-100 OP119614
Policy instance 1
Insurance contract or identification numberMG-100 OP119614
Number of Individuals Covered22
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,201
Other welfare benefits providedMAJOR MEDICAL SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,201
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 3
Number of Individuals Covered54
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,829
Other welfare benefits providedGROUP CANCER & SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $22,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,484
Insurance broker organization code?3
Insurance broker nameBAFFIN BAY MARKETING GROUP, LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919000
Policy instance 4
Insurance contract or identification number9041465919000
Number of Individuals Covered85
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $-4
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-4
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016902-00
Policy instance 5
Insurance contract or identification number01-016902-00
Number of Individuals Covered124
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,515
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $26,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,047
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919001
Policy instance 6
Insurance contract or identification number9041465919001
Number of Individuals Covered43
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,598
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $24,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,504
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 7
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $168
Other welfare benefits providedINDIVIDUAL CANCER/SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $115
Insurance broker organization code?3
Insurance broker nameASPEN REINSURANCE GROUP, INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number908346
Policy instance 8
Insurance contract or identification number908346
Number of Individuals Covered182
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,908
Total amount of fees paid to insurance companyUSD $28,230
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $639,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,908
Amount paid for insurance broker fees28230
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT & BONUS
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 4
Number of Individuals Covered4
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $135
Health Insurance Welfare BenefitYes
Other welfare benefits providedHEART/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $1,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135
Insurance broker organization code?3
Insurance broker nameH. CHARLES BROOKS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919001
Policy instance 8
Insurance contract or identification number9041465919001
Number of Individuals Covered38
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,873
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $26,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,873
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVFM
Policy instance 7
Insurance contract or identification numberG000AVFM
Number of Individuals Covered131
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,338
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,338
Insurance broker organization code?3
Insurance broker nameHOWARD CHARLES BROOKS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919000
Policy instance 6
Insurance contract or identification number9041465919000
Number of Individuals Covered85
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,340
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,340
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMG-100 OP119614
Policy instance 3
Insurance contract or identification numberMG-100 OP119614
Number of Individuals Covered35
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,152
Other welfare benefits providedMAJOR MEDICAL SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $36,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,152
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 )
Policy contract number333560
Policy instance 2
Insurance contract or identification number333560
Number of Individuals Covered91
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $562
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $562
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTIONS INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 5
Number of Individuals Covered46
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,370
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $22,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,370
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTION
S & W HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95099 )
Policy contract number007787
Policy instance 1
Insurance contract or identification number007787
Number of Individuals Covered115
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $14,890
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $550,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,890
Insurance broker organization code?3
Insurance broker nameSCOTT & WHITE HEALTH PLAN
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919001
Policy instance 8
Insurance contract or identification number9041465919001
Number of Individuals Covered42
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,038
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $26,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,038
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 7
Insurance contract or identification number863001G
Number of Individuals Covered134
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,332
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $24,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,908
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC.
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919000
Policy instance 6
Insurance contract or identification number9041465919000
Number of Individuals Covered82
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,900
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,900
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 5
Number of Individuals Covered47
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,105
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $25,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,105
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTION
S & W HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95099 )
Policy contract number007787
Policy instance 1
Insurance contract or identification number007787
Number of Individuals Covered133
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,129
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $404,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,129
Insurance broker organization code?3
Insurance broker nameSCOTT & WHITE HEALTH PLAN
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMG-100 OP119614
Policy instance 3
Insurance contract or identification numberMG-100 OP119614
Number of Individuals Covered30
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,240
Other welfare benefits providedMAJOR MEDICAL SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $42,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,240
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 )
Policy contract number333560
Policy instance 2
Insurance contract or identification number333560
Number of Individuals Covered97
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $527
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $527
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTIONS INC
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 4
Number of Individuals Covered4
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $191
Health Insurance Welfare BenefitYes
Other welfare benefits providedHEART/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $1,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $191
Insurance broker organization code?3
Insurance broker nameH. CHARLES BROOKS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 7
Insurance contract or identification number863001G
Number of Individuals Covered137
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,992
Total amount of fees paid to insurance companyUSD $399
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,395
Insurance broker organization code?3
Amount paid for insurance broker fees399
Additional information about fees paid to insurance brokerOTHER
Insurance broker nameINS POINT LLC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-400089
Policy instance 2
Insurance contract or identification number010-400089
Number of Individuals Covered101
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $656
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $656
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberMG-100 OP119614
Policy instance 3
Insurance contract or identification numberMG-100 OP119614
Number of Individuals Covered34
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,231
Other welfare benefits providedMAJOR MEDICAL SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $42,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,231
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 4
Number of Individuals Covered5
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $230
Health Insurance Welfare BenefitYes
Other welfare benefits providedHEART/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $2,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $230
Insurance broker organization code?3
Insurance broker nameH. CHARLES BROOKS
SOUTHWEST LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 66117 )
Policy contract numberP62W85
Policy instance 6
Insurance contract or identification numberP62W85
Number of Individuals Covered19
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,921
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SHA, L.L.C. (National Association of Insurance Commissioners NAIC id number: 95138 )
Policy contract number62W200
Policy instance 1
Insurance contract or identification number62W200
Number of Individuals Covered112
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,349
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,027
Insurance broker organization code?3
Insurance broker nameINSOURCE BENEFITS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919000
Policy instance 7
Insurance contract or identification number9041465919000
Number of Individuals Covered86
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,978
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 8
Insurance contract or identification number863001G
Number of Individuals Covered137
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,992
Total amount of fees paid to insurance companyUSD $399
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919001
Policy instance 8
Insurance contract or identification number9041465919001
Number of Individuals Covered42
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,937
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $30,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,937
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919001
Policy instance 9
Insurance contract or identification number9041465919001
Number of Individuals Covered42
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,937
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $30,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number9041465919000
Policy instance 6
Insurance contract or identification number9041465919000
Number of Individuals Covered86
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,978
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,978
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 5
Number of Individuals Covered59
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,428
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $27,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,259
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTIONS
SHA, L.L.C. (National Association of Insurance Commissioners NAIC id number: 95138 )
Policy contract number62W200
Policy instance 1
Insurance contract or identification number62W200
Number of Individuals Covered112
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,349
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,349
Insurance broker organization code?3
Insurance broker nameINSOURCE BENEFITS
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-400089
Policy instance 2
Insurance contract or identification number010-400089
Number of Individuals Covered110
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $526
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $526
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 4
Number of Individuals Covered5
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $212
Health Insurance Welfare BenefitYes
Other welfare benefits providedHEART/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $2,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $212
Insurance broker organization code?3
Insurance broker nameH. CHARLES BROOKS
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 5
Number of Individuals Covered63
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,502
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $28,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,502
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SOLUTION
SOUTHWEST LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 66117 )
Policy contract numberP62W85
Policy instance 6
Insurance contract or identification numberP62W85
Number of Individuals Covered19
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,921
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,921
Insurance broker organization code?3
Insurance broker nameINSOURCE BENEFITS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number000AST000
Policy instance 7
Insurance contract or identification number000AST000
Number of Individuals Covered84
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,571
Dental Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $56,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,838
Insurance broker organization code?3
Insurance broker nameBENEFIT RESEARCH CORPORATION
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 8
Insurance contract or identification number863001G
Number of Individuals Covered140
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,425
Total amount of fees paid to insurance companyUSD $443
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,655
Insurance broker organization code?3
Amount paid for insurance broker fees443
Additional information about fees paid to insurance brokerOTHER
Insurance broker nameINS POINT LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 1
Insurance contract or identification number863001G
Number of Individuals Covered126
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,318
Total amount of fees paid to insurance companyUSD $332
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,590
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 number010-400089
Policy instance 3
Insurance contract or identification number010-400089
Number of Individuals Covered40
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $459
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SHA, L.L.C. (National Association of Insurance Commissioners NAIC id number: 95138 )
Policy contract number62W200
Policy instance 2
Insurance contract or identification number62W200
Number of Individuals Covered116
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,469
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $279,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 5
Number of Individuals Covered9
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $582
Health Insurance Welfare BenefitYes
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $5,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 6
Number of Individuals Covered71
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,926
Other welfare benefits providedCANCER AND SPECIFIED DISEASE
Welfare Benefit Premiums Paid to CarrierUSD $24,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SOUTHWEST LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 66117 )
Policy contract numberP62W85
Policy instance 7
Insurance contract or identification numberP62W85
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $150
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number000AST000
Policy instance 8
Insurance contract or identification number000AST000
Number of Individuals Covered112
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,809
Dental Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY STD
Welfare Benefit Premiums Paid to CarrierUSD $57,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract number720808900
Policy instance 2
Insurance contract or identification number720808900
Number of Individuals Covered21
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,436
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberC30551
Policy instance 3
Insurance contract or identification numberC30551
Number of Individuals Covered22
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,978
Total amount of fees paid to insurance companyUSD $1,682
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $16,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number
Policy instance 4
Number of Individuals Covered10
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,084
Total amount of fees paid to insurance companyUSD $414
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $4,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number863001G
Policy instance 8
Insurance contract or identification number863001G
Number of Individuals Covered125
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,412
Total amount of fees paid to insurance companyUSD $128
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SOUTHWEST LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 66117 )
Policy contract number62W200
Policy instance 7
Insurance contract or identification number62W200
Number of Individuals Covered101
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $13,080
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $335,325
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 number010-400089
Policy instance 6
Insurance contract or identification number010-400089
Number of Individuals Covered37
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $3,982
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract numberSRP1383
Policy instance 1
Insurance contract or identification numberSRP1383
Number of Individuals Covered5
Total amount of commissions paid to insurance brokerUSD $339
Total amount of fees paid to insurance companyUSD $212
Other welfare benefits providedHEART ATTACK/STROKE
Welfare Benefit Premiums Paid to CarrierUSD $2,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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