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SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 401k Plan overview

Plan NameSOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL
Plan identification number 502

SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

SOUTHERN METHODIST UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name:SOUTHERN METHODIST UNIVERSITY
Employer identification number (EIN):750800689
NAIC Classification:611000

Additional information about SOUTHERN METHODIST UNIVERSITY

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1911-04-11
Company Identification Number: 0002306601
Legal Registered Office Address: PO BOX 750233

DALLAS
United States of America (USA)
75275

More information about SOUTHERN METHODIST UNIVERSITY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01SHERI A. STARKEY
5022016-01-01SHERI A. STARKEY
5022015-01-01SHERI A. STARKEY
5022014-01-01SHERI A. STARKEY
5022013-01-01SHERI A. STARKEY
5022012-01-01SHERI A. STARKEY
5022011-01-01SHERI A. STARKEY
5022009-01-01SHERI A. STARKEY SHERI A. STARKEY2010-10-04
5022009-01-01SHERI A. STARKEY SHERI A. STARKEY2010-10-04

Plan Statistics for SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL

401k plan membership statisitcs for SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL

Measure Date Value
2022: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2022 401k membership
Total participants, beginning-of-year2022-01-014,778
Total number of active participants reported on line 7a of the Form 55002022-01-014,731
Number of retired or separated participants receiving benefits2022-01-0194
Number of other retired or separated participants entitled to future benefits2022-01-0130
Total of all active and inactive participants2022-01-014,855
2021: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2021 401k membership
Total participants, beginning-of-year2021-01-014,875
Total number of active participants reported on line 7a of the Form 55002021-01-014,778
Number of retired or separated participants receiving benefits2021-01-0195
Number of other retired or separated participants entitled to future benefits2021-01-0162
Total of all active and inactive participants2021-01-014,935
2020: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2020 401k membership
Total participants, beginning-of-year2020-01-014,843
Total number of active participants reported on line 7a of the Form 55002020-01-014,875
Number of retired or separated participants receiving benefits2020-01-01103
Number of other retired or separated participants entitled to future benefits2020-01-0129
Total of all active and inactive participants2020-01-015,007
Total participants2020-01-015,007
2019: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2019 401k membership
Total participants, beginning-of-year2019-01-014,984
Total number of active participants reported on line 7a of the Form 55002019-01-014,843
Number of retired or separated participants receiving benefits2019-01-01113
Number of other retired or separated participants entitled to future benefits2019-01-0142
Total of all active and inactive participants2019-01-014,998
Total participants2019-01-014,998
2018: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2018 401k membership
Total participants, beginning-of-year2018-01-014,740
Total number of active participants reported on line 7a of the Form 55002018-01-014,846
Number of retired or separated participants receiving benefits2018-01-01100
Number of other retired or separated participants entitled to future benefits2018-01-0138
Total of all active and inactive participants2018-01-014,984
Total participants2018-01-014,984
2017: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2017 401k membership
Total participants, beginning-of-year2017-01-014,554
Total number of active participants reported on line 7a of the Form 55002017-01-014,618
Number of retired or separated participants receiving benefits2017-01-01102
Number of other retired or separated participants entitled to future benefits2017-01-0120
Total of all active and inactive participants2017-01-014,740
Total participants2017-01-014,740
2016: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2016 401k membership
Total participants, beginning-of-year2016-01-014,552
Total number of active participants reported on line 7a of the Form 55002016-01-014,466
Number of retired or separated participants receiving benefits2016-01-0177
Number of other retired or separated participants entitled to future benefits2016-01-0111
Total of all active and inactive participants2016-01-014,554
Total participants2016-01-014,554
2015: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2015 401k membership
Total participants, beginning-of-year2015-01-014,549
Total number of active participants reported on line 7a of the Form 55002015-01-013,800
Number of retired or separated participants receiving benefits2015-01-01693
Number of other retired or separated participants entitled to future benefits2015-01-0159
Total of all active and inactive participants2015-01-014,552
Total participants2015-01-014,552
2014: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2014 401k membership
Total participants, beginning-of-year2014-01-014,752
Total number of active participants reported on line 7a of the Form 55002014-01-014,053
Number of retired or separated participants receiving benefits2014-01-01431
Number of other retired or separated participants entitled to future benefits2014-01-0165
Total of all active and inactive participants2014-01-014,549
Total participants2014-01-014,549
2013: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2013 401k membership
Total participants, beginning-of-year2013-01-014,455
Total number of active participants reported on line 7a of the Form 55002013-01-014,472
Number of other retired or separated participants entitled to future benefits2013-01-01280
Total of all active and inactive participants2013-01-014,752
Total participants2013-01-014,752
2012: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2012 401k membership
Total participants, beginning-of-year2012-01-012,145
Total number of active participants reported on line 7a of the Form 55002012-01-014,407
Number of other retired or separated participants entitled to future benefits2012-01-0148
Total of all active and inactive participants2012-01-014,455
Total participants2012-01-014,455
2011: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2011 401k membership
Total participants, beginning-of-year2011-01-011,973
Total number of active participants reported on line 7a of the Form 55002011-01-012,118
Number of other retired or separated participants entitled to future benefits2011-01-0127
Total of all active and inactive participants2011-01-012,145
Total participants2011-01-012,145
2009: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2009 401k membership
Total participants, beginning-of-year2009-01-012,250
Total number of active participants reported on line 7a of the Form 55002009-01-012,129
Number of retired or separated participants receiving benefits2009-01-0134
Number of other retired or separated participants entitled to future benefits2009-01-0161
Total of all active and inactive participants2009-01-012,224

Form 5500 Responses for SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL

2022: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
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: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: SOUTHERN METHODIST UNIVERSITY MEDICAL AND OTHER PL 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 5
Insurance contract or identification number750966
Number of Individuals Covered479
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedDEPENDENT GROUP LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $56,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 4
Insurance contract or identification number750966
Number of Individuals Covered659
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $521,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 3
Insurance contract or identification number750966
Number of Individuals Covered973
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSMUV0-001
Policy instance 2
Insurance contract or identification numberSMUV0-001
Number of Individuals Covered2386
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $76,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016102
Policy instance 1
Insurance contract or identification number30016102
Number of Individuals Covered1712
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,707
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $245,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,707
Additional information about fees paid to insurance brokerN/A
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016102
Policy instance 1
Insurance contract or identification number30016102
Number of Individuals Covered1775
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,679
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $245,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,679
Additional information about fees paid to insurance brokerN/A
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSMUV0-001
Policy instance 2
Insurance contract or identification numberSMUV0-001
Number of Individuals Covered2418
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $37,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 3
Insurance contract or identification number750966
Number of Individuals Covered1033
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 4
Insurance contract or identification number750966
Number of Individuals Covered687
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $524,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 5
Insurance contract or identification number750966
Number of Individuals Covered487
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedDEPENDENT GROUP LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $57,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 5
Insurance contract or identification number750966
Number of Individuals Covered479
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedDEPENDENT GROUP LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $54,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 4
Insurance contract or identification number750966
Number of Individuals Covered678
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $476,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 3
Insurance contract or identification number750966
Number of Individuals Covered1015
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSMUV0-001
Policy instance 2
Insurance contract or identification numberSMUV0-001
Number of Individuals Covered2473
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $37,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016102
Policy instance 1
Insurance contract or identification number30016102
Number of Individuals Covered1786
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,374
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $244,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,374
Additional information about fees paid to insurance brokerN/A
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016102
Policy instance 1
Insurance contract or identification number30016102
Number of Individuals Covered1739
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,245
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $234,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,245
Additional information about fees paid to insurance brokerN/A
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSMUV0-001
Policy instance 2
Insurance contract or identification numberSMUV0-001
Number of Individuals Covered2490
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $37,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 3
Insurance contract or identification number750966
Number of Individuals Covered989
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 4
Insurance contract or identification number750966
Number of Individuals Covered643
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $454,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 5
Insurance contract or identification number750966
Number of Individuals Covered454
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedDEPENDENT GROUP LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $52,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 5
Insurance contract or identification number750966
Number of Individuals Covered408
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedDEPENDENT GROUP LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $52,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameANBTX INS SERVICES INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 4
Insurance contract or identification number750966
Number of Individuals Covered581
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $430,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameANBTX INS SERVICES INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number750966
Policy instance 3
Insurance contract or identification number750966
Number of Individuals Covered900
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameANBTX INS SERVICES INC
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberSMUV0-001
Policy instance 2
Insurance contract or identification numberSMUV0-001
Number of Individuals Covered2400
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $32,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016102
Policy instance 1
Insurance contract or identification number30016102
Number of Individuals Covered1650
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,113
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,113
Additional information about fees paid to insurance brokerN/A
Insurance broker nameHOLMES MURPHY AND ASSOCIATES INC

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