COVERT BUICK, INC. has sponsored the creation of one or more 401k plans.
Additional information about COVERT BUICK, INC.
Submission information for form 5500 for 401k plan COVERT BUICK INC. GROUP INSURANCE PLAN
401k plan membership statisitcs for COVERT BUICK INC. GROUP INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2021: COVERT BUICK INC. GROUP INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 1,055 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 481 |
| Total of all active and inactive participants | 2021-11-01 | 481 |
| 2020: COVERT BUICK INC. GROUP INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 872 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 1,055 |
| Total of all active and inactive participants | 2020-11-01 | 1,055 |
| 2019: COVERT BUICK INC. GROUP INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 751 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 872 |
| Total of all active and inactive participants | 2019-11-01 | 872 |
| 2018: COVERT BUICK INC. GROUP INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 769 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 751 |
| Total of all active and inactive participants | 2018-11-01 | 751 |
| 2017: COVERT BUICK INC. GROUP INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 753 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 769 |
| Total of all active and inactive participants | 2017-11-01 | 769 |
| 2016: COVERT BUICK INC. GROUP INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 731 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 753 |
| Total of all active and inactive participants | 2016-11-01 | 753 |
| 2015: COVERT BUICK INC. GROUP INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 660 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 731 |
| Total of all active and inactive participants | 2015-11-01 | 731 |
| 2014: COVERT BUICK INC. GROUP INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 584 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 660 |
| Total of all active and inactive participants | 2014-11-01 | 660 |
| 2013: COVERT BUICK INC. GROUP INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 532 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 584 |
| Total of all active and inactive participants | 2013-11-01 | 584 |
| 2012: COVERT BUICK INC. GROUP INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 467 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 532 |
| Total of all active and inactive participants | 2012-11-01 | 532 |
| 2011: COVERT BUICK INC. GROUP INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 445 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 467 |
| Total of all active and inactive participants | 2011-11-01 | 467 |
| 2010: COVERT BUICK INC. GROUP INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 526 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 445 |
| Total of all active and inactive participants | 2010-11-01 | 445 |
| 2009: COVERT BUICK INC. GROUP INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 575 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 526 |
| Total of all active and inactive participants | 2009-11-01 | 526 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F026779 |
| Policy instance | 9 |
| Insurance contract or identification number | F026779 | | Number of Individuals Covered | 510 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $6,051 | | Total amount of fees paid to insurance company | USD $2,931 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,051 | | Amount paid for insurance broker fees | 2931 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0120513 |
| Policy instance | 1 |
| Insurance contract or identification number | 0120513 | | Number of Individuals Covered | 481 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $89,226 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $153,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,075 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 4052408 |
| Policy instance | 2 |
| Insurance contract or identification number | 4052408 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $7,300 | | Total amount of fees paid to insurance company | USD $7,060 | | Other welfare benefits provided | MEDICAL GAP COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $48,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,300 | | Amount paid for insurance broker fees | 7060 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AL95 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AL95 | | Number of Individuals Covered | 1688 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-11-01 | | Total amount of commissions paid to insurance broker | USD $2,775 | | Total amount of fees paid to insurance company | USD $6,605 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5172 | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $2,775 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AL95 |
| Policy instance | 4 |
| Insurance contract or identification number | GUPR0AL95 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-11-01 | | Total amount of commissions paid to insurance broker | USD $9,621 | | Total amount of fees paid to insurance company | USD $6,535 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,621 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5413 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AL95 |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AL95 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-11-01 | | Total amount of commissions paid to insurance broker | USD $16,403 | | Total amount of fees paid to insurance company | USD $13,220 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $164,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,403 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7424 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AL95 |
| Policy instance | 6 |
| Insurance contract or identification number | GVTL0AL95 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-11-01 | | Total amount of commissions paid to insurance broker | USD $19,538 | | Total amount of fees paid to insurance company | USD $15,395 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D-VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $195,379 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,538 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 9653 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05973361 |
| Policy instance | 7 |
| Insurance contract or identification number | KM05973361 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $3,485 | | Total amount of fees paid to insurance company | USD $469 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,485 | | Insurance broker organization code? | 5 | | Amount paid for insurance broker fees | 435 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 324313 |
| Policy instance | 8 |
| Insurance contract or identification number | 324313 | | Number of Individuals Covered | 1178 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $182,571 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,627,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $182,571 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0120513 |
| Policy instance | 1 |
| Insurance contract or identification number | 0120513 | | Number of Individuals Covered | 1055 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $118,669 | | Total amount of fees paid to insurance company | USD $27,840 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,976,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $103,735 | | Amount paid for insurance broker fees | 27840 | | Additional information about fees paid to insurance broker | 2020 PINNACLE MEDICAL RETENTION INCENTIVE RISK | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 4052408 |
| Policy instance | 2 |
| Insurance contract or identification number | 4052408 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,338 | | Total amount of fees paid to insurance company | USD $9,031 | | Other welfare benefits provided | MEDICAL GAP COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $62,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,338 | | Amount paid for insurance broker fees | 9031 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AL95 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AL95 | | Number of Individuals Covered | 854 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-05-01 | | Total amount of commissions paid to insurance broker | USD $2,374 | | Total amount of fees paid to insurance company | USD $6,282 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $23,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4920 | | Additional information about fees paid to insurance broker | ADMINISTRATION | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $2,374 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AL95 |
| Policy instance | 4 |
| Insurance contract or identification number | GUPR0AL95 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-05-01 | | Total amount of commissions paid to insurance broker | USD $10,432 | | Total amount of fees paid to insurance company | USD $9,699 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,432 | | Amount paid for insurance broker fees | 5997 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AL95 |
| Policy instance | 5 |
| Insurance contract or identification number | GUC 0AL95 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-05-01 | | Total amount of commissions paid to insurance broker | USD $13,012 | | Total amount of fees paid to insurance company | USD $12,318 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $130,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,012 | | Amount paid for insurance broker fees | 7566 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AL95 |
| Policy instance | 6 |
| Insurance contract or identification number | GVTL0AL95 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-05-01 | | Total amount of commissions paid to insurance broker | USD $17,253 | | Total amount of fees paid to insurance company | USD $14,918 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D-VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $172,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,253 | | Amount paid for insurance broker fees | 9998 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05973361 |
| Policy instance | 7 |
| Insurance contract or identification number | KM05973361 | | Number of Individuals Covered | 1531 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $34,545 | | Total amount of fees paid to insurance company | USD $4,319 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $377,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,545 | | Amount paid for insurance broker fees | 4319 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000023515 |
| Policy instance | 8 |
| Insurance contract or identification number | 0000023515 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,008 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT/CRITICAL ILLNESS PLANS | | Welfare Benefit Premiums Paid to Carrier | USD $35,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,518 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AL95 |
| Policy instance | 7 |
| Insurance contract or identification number | GVTL0AL95 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-05-01 | | Total amount of commissions paid to insurance broker | USD $15,925 | | Total amount of fees paid to insurance company | USD $13,333 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D-VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $159,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,925 | | Amount paid for insurance broker fees | 9211 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AL95 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC 0AL95 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-05-01 | | Total amount of commissions paid to insurance broker | USD $12,066 | | Total amount of fees paid to insurance company | USD $11,656 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $120,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,066 | | Amount paid for insurance broker fees | 7282 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AL95 |
| Policy instance | 5 |
| Insurance contract or identification number | GUPR0AL95 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-05-01 | | Total amount of commissions paid to insurance broker | USD $9,227 | | Total amount of fees paid to insurance company | USD $8,676 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,227 | | Amount paid for insurance broker fees | 5658 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AL95 |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AL95 | | Number of Individuals Covered | 765 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-05-01 | | Total amount of commissions paid to insurance broker | USD $2,155 | | Total amount of fees paid to insurance company | USD $5,654 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $21,550 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4374 | | Additional information about fees paid to insurance broker | ADMINISTRATION | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $2,155 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00461813 |
| Policy instance | 3 |
| Insurance contract or identification number | 00461813 | | Number of Individuals Covered | 472 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-13 | | Total amount of commissions paid to insurance broker | USD $35,208 | | Total amount of fees paid to insurance company | USD $3,023 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $352,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,208 | | Amount paid for insurance broker fees | 3023 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 4052408 |
| Policy instance | 2 |
| Insurance contract or identification number | 4052408 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $8,459 | | Total amount of fees paid to insurance company | USD $8,181 | | Other welfare benefits provided | MEDICAL GAP COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $56,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,459 | | Amount paid for insurance broker fees | 8181 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0120513 |
| Policy instance | 1 |
| Insurance contract or identification number | 0120513 | | Number of Individuals Covered | 872 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $83,957 | | Total amount of fees paid to insurance company | USD $103 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,843,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $83,957 | | Amount paid for insurance broker fees | 103 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 4052408 |
| Policy instance | 2 |
| Insurance contract or identification number | 4052408 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $7,568 | | Total amount of fees paid to insurance company | USD $7,320 | | Other welfare benefits provided | MEDICAL GAP COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $50,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,568 | | Amount paid for insurance broker fees | 7320 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 |
|
| HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 ) |
| Policy contract number | 866835 |
| Policy instance | 1 |
| Insurance contract or identification number | 866835 | | Number of Individuals Covered | 451 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $64,351 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,253,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,216 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00461813 |
| Policy instance | 3 |
| Insurance contract or identification number | 00461813 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-13 | | Total amount of commissions paid to insurance broker | USD $32,762 | | Total amount of fees paid to insurance company | USD $10,164 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $327,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,762 | | Amount paid for insurance broker fees | 10164 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AL95 |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AL95 | | Number of Individuals Covered | 751 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-05-01 | | Total amount of commissions paid to insurance broker | USD $2,076 | | Total amount of fees paid to insurance company | USD $1,033 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $20,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,076 | | Amount paid for insurance broker fees | 1033 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0AL95 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC 0AL95 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-05-01 | | Total amount of commissions paid to insurance broker | USD $11,905 | | Total amount of fees paid to insurance company | USD $5,785 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,905 | | Amount paid for insurance broker fees | 5785 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0AL95 |
| Policy instance | 5 |
| Insurance contract or identification number | GUPR0AL95 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-05-01 | | Total amount of commissions paid to insurance broker | USD $9,670 | | Total amount of fees paid to insurance company | USD $4,767 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,670 | | Amount paid for insurance broker fees | 4767 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AL95 |
| Policy instance | 7 |
| Insurance contract or identification number | GVTL0AL95 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-05-01 | | Total amount of commissions paid to insurance broker | USD $14,639 | | Total amount of fees paid to insurance company | USD $7,380 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D-VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $146,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,639 | | Amount paid for insurance broker fees | 7380 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 4052408 |
| Policy instance | 2 |
| Insurance contract or identification number | 4052408 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $5,543 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICAL GAP COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $36,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00461813 |
| Policy instance | 3 |
| Insurance contract or identification number | 00461813 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-13 | | Total amount of commissions paid to insurance broker | USD $33,140 | | Total amount of fees paid to insurance company | USD $9,866 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $331,401 | | 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 number | GLUG0AL95 |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AL95 | | Number of Individuals Covered | 726 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-05-01 | | Total amount of commissions paid to insurance broker | USD $2,085 | | Total amount of fees paid to insurance company | USD $1,254 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $20,848 | | 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 number | GUPR0AL95 |
| Policy instance | 5 |
| Insurance contract or identification number | GUPR0AL95 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-05-01 | | Total amount of commissions paid to insurance broker | USD $9,651 | | Total amount of fees paid to insurance company | USD $5,838 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,509 | | 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 number | GUC 0AL95 |
| Policy instance | 6 |
| Insurance contract or identification number | GUC 0AL95 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-05-01 | | Total amount of commissions paid to insurance broker | USD $11,435 | | Total amount of fees paid to insurance company | USD $6,963 | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $114,346 | | 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 number | GVTL0AL95 |
| Policy instance | 7 |
| Insurance contract or identification number | GVTL0AL95 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-05-01 | | Total amount of commissions paid to insurance broker | USD $15,084 | | Total amount of fees paid to insurance company | USD $8,958 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D-VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $150,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 098899 |
| Policy instance | 1 |
| Insurance contract or identification number | 098899 | | Number of Individuals Covered | 769 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $59,679 | | Total amount of fees paid to insurance company | USD $2,122 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,037,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
