ATZENHOFFER CHEVROLET COMPANY, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ATZENHOFFER CHEVROLET COMPANY PLAN
| Measure | Date | Value |
|---|
| 2020: ATZENHOFFER CHEVROLET COMPANY PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 154 |
| Total of all active and inactive participants | 2020-08-01 | 154 |
| Total participants | 2020-08-01 | 154 |
| 2019: ATZENHOFFER CHEVROLET COMPANY PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 126 |
| Total of all active and inactive participants | 2019-08-01 | 126 |
| Total participants | 2019-08-01 | 126 |
| 2018: ATZENHOFFER CHEVROLET COMPANY PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 140 |
| Total of all active and inactive participants | 2018-08-01 | 140 |
| Total participants | 2018-08-01 | 140 |
| 2017: ATZENHOFFER CHEVROLET COMPANY PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 143 |
| Total of all active and inactive participants | 2017-08-01 | 143 |
| Total participants | 2017-08-01 | 143 |
| 2016: ATZENHOFFER CHEVROLET COMPANY PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 153 |
| Total of all active and inactive participants | 2016-08-01 | 153 |
| Total participants | 2016-08-01 | 153 |
| 2015: ATZENHOFFER CHEVROLET COMPANY PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 143 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
| Total of all active and inactive participants | 2015-08-01 | 143 |
| 2014: ATZENHOFFER CHEVROLET COMPANY PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 148 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
| Total of all active and inactive participants | 2014-08-01 | 148 |
| 2013: ATZENHOFFER CHEVROLET COMPANY PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 143 |
| Total of all active and inactive participants | 2013-08-01 | 143 |
| Total participants | 2013-08-01 | 0 |
| 2012: ATZENHOFFER CHEVROLET COMPANY PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 134 |
| Total of all active and inactive participants | 2012-08-01 | 134 |
| Total participants | 2012-08-01 | 0 |
| 2011: ATZENHOFFER CHEVROLET COMPANY PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 134 |
| Total of all active and inactive participants | 2011-08-01 | 134 |
| Total participants | 2011-08-01 | 134 |
| 2009: ATZENHOFFER CHEVROLET COMPANY PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 116 |
| Total of all active and inactive participants | 2009-08-01 | 116 |
| Total participants | 2009-08-01 | 116 |
| 2020: ATZENHOFFER CHEVROLET COMPANY PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: ATZENHOFFER CHEVROLET COMPANY PLAN 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: ATZENHOFFER CHEVROLET COMPANY PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: ATZENHOFFER CHEVROLET COMPANY PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: ATZENHOFFER CHEVROLET COMPANY PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: ATZENHOFFER CHEVROLET COMPANY PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: ATZENHOFFER CHEVROLET COMPANY PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: ATZENHOFFER CHEVROLET COMPANY PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: ATZENHOFFER CHEVROLET COMPANY PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: ATZENHOFFER CHEVROLET COMPANY PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: ATZENHOFFER CHEVROLET COMPANY PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0921841 |
| Policy instance | 2 |
| Insurance contract or identification number | 0921841 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $26,568 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $562,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,568 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 000VY398 |
| Policy instance | 1 |
| Insurance contract or identification number | 000VY398 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of fees paid to insurance company | USD $3,509 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3509 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 000TS853 |
| Policy instance | 1 |
| Insurance contract or identification number | 000TS853 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $7,723 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,723 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 28630 |
| Policy instance | 2 |
| Insurance contract or identification number | 28630 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $44,130 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $659,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,130 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 000TS853 |
| Policy instance | 1 |
| Insurance contract or identification number | 000TS853 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $11,546 | | Total amount of fees paid to insurance company | USD $5,316 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $11,546 | | Amount paid for insurance broker fees | 5316 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 28630 |
| Policy instance | 2 |
| Insurance contract or identification number | 28630 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $33,505 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $734,899 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,505 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00TS853 |
| Policy instance | 1 |
| Insurance contract or identification number | 00TS853 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2016-08-01 | | Insurance policy end date | 2017-07-31 | | Total amount of commissions paid to insurance broker | USD $9,673 | | Total amount of fees paid to insurance company | USD $5,268 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,664 | | Amount paid for insurance broker fees | 5268 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN J. MCGURRAN |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 28630 |
| Policy instance | 2 |
| Insurance contract or identification number | 28630 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $32,426 | | Total amount of fees paid to insurance company | USD $855 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $653,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,426 | | Amount paid for insurance broker fees | 855 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS, JR. |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 28630 |
| Policy instance | 1 |
| Insurance contract or identification number | 28630 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $34,787 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $700,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,787 | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS, JR. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 000TS853 |
| Policy instance | 2 |
| Insurance contract or identification number | 000TS853 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $8,893 | | Total amount of fees paid to insurance company | USD $3,428 | | Welfare Benefit Premiums Paid to Carrier | USD $73,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,893 | | Amount paid for insurance broker fees | 3428 | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 028630 |
| Policy instance | 2 |
| Insurance contract or identification number | 028630 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $34,371 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $687,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,371 | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS, JR. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459442 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459442 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $9,755 | | Total amount of fees paid to insurance company | USD $3,975 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,659 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3975 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker name | W INSURANCE GROUP, LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459442 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459442 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $9,009 | | Total amount of fees paid to insurance company | USD $4,464 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,919 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4464 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker name | ERIK G. LILJENWALL |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 028630 |
| Policy instance | 2 |
| Insurance contract or identification number | 028630 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $29,982 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $592,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,982 | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS, JR. |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 28630 |
| Policy instance | 1 |
| Insurance contract or identification number | 28630 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $22,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $514,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,000 | | Insurance broker name | JESS B. WILLIAMS, JR. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459442 |
| Policy instance | 2 |
| Insurance contract or identification number | 00459442 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $8,815 | | Total amount of fees paid to insurance company | USD $4,337 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4 | | Amount paid for insurance broker fees | 4337 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JESS B. WILLIAMS , JR. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459442 |
| Policy instance | 2 |
| Insurance contract or identification number | 00459442 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $8,723 | | Total amount of fees paid to insurance company | USD $4,028 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,311 | | 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 | 028630 |
| Policy instance | 1 |
| Insurance contract or identification number | 028630 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $25,867 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $517,676 | | 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 | TS853 |
| Policy instance | 2 |
| Insurance contract or identification number | TS853 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $7,220 | | Total amount of fees paid to insurance company | USD $1,370 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,365 | | 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 | 028630 |
| Policy instance | 1 |
| Insurance contract or identification number | 028630 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $26,502 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $508,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
