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SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN
Plan identification number 505

SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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

SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. has sponsored the creation of one or more 401k plans.

Company Name:SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Employer identification number (EIN):751230219
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1965-11-23
Company Identification Number: 0021891601
Legal Registered Office Address: PO BOX 610

LEVELLAND
United States of America (USA)
79336

More information about SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01
5052021-01-01
5052020-01-01
5052019-01-01
5052018-01-01ROGER CARDENAS
5052017-01-01ROGER CARDENAS
5052016-01-01ROGER CARDENAS
5052015-01-01ROGER CARDERAS
5052014-04-01ANDY CATES
5052013-04-01ANDY CATES

Plan Statistics for SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01469
Total number of active participants reported on line 7a of the Form 55002022-01-01465
Total of all active and inactive participants2022-01-01465
Total participants2022-01-01465
2021: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01474
Total number of active participants reported on line 7a of the Form 55002021-01-01469
Total of all active and inactive participants2021-01-01469
Total participants2021-01-01469
2020: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01451
Total number of active participants reported on line 7a of the Form 55002020-01-01474
Total of all active and inactive participants2020-01-01474
Total participants2020-01-01474
2019: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01428
Total number of active participants reported on line 7a of the Form 55002019-01-01451
Total of all active and inactive participants2019-01-01451
Total participants2019-01-01451
Number of participants with account balances2019-01-010
2018: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01349
Total number of active participants reported on line 7a of the Form 55002018-01-01428
Total of all active and inactive participants2018-01-01428
Total participants2018-01-01428
2017: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01379
Total number of active participants reported on line 7a of the Form 55002017-01-01349
Total of all active and inactive participants2017-01-01349
Total participants2017-01-01349
2016: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01446
Total number of active participants reported on line 7a of the Form 55002016-01-01379
Total of all active and inactive participants2016-01-01379
Total participants2016-01-01379
2015: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01417
Total number of active participants reported on line 7a of the Form 55002015-01-01446
Total of all active and inactive participants2015-01-01446
Total participants2015-01-010
2014: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01367
Total number of active participants reported on line 7a of the Form 55002014-04-01417
Total of all active and inactive participants2014-04-01417
Total participants2014-04-010
2013: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-010
Total number of active participants reported on line 7a of the Form 55002013-04-01367
Total of all active and inactive participants2013-04-01367
Total participants2013-04-010

Form 5500 Responses for SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN

2022: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT 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: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01First time form 5500 has been submittedYes
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BN7J
Policy instance 6
Insurance contract or identification numberGVTL0BN7J
Number of Individuals Covered269
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,957
Total amount of fees paid to insurance companyUSD $5,671
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $95,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,957
Amount paid for insurance broker fees5671
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0BN7J
Policy instance 5
Insurance contract or identification numberGUG0BN7J
Number of Individuals Covered465
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,803
Total amount of fees paid to insurance companyUSD $5,283
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $94,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,803
Amount paid for insurance broker fees5283
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BN7J
Policy instance 4
Insurance contract or identification numberGLUG0BN7J
Number of Individuals Covered465
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,639
Total amount of fees paid to insurance companyUSD $1,236
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,639
Amount paid for insurance broker fees1236
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BN7J
Policy instance 3
Insurance contract or identification numberGLTD0BN7J
Number of Individuals Covered465
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $15,163
Total amount of fees paid to insurance companyUSD $6,837
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,163
Amount paid for insurance broker fees6837
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-052464
Policy instance 2
Insurance contract or identification number010-052464
Number of Individuals Covered937
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $29,105
Total amount of fees paid to insurance companyUSD $7,885
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $291,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,105
Insurance broker organization code?3
Amount paid for insurance broker fees7885
Additional information about fees paid to insurance brokerSERVICE FEES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0920408
Policy instance 1
Insurance contract or identification number0920408
Number of Individuals Covered455
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $176,997
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,364,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees176997
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0920408
Policy instance 1
Insurance contract or identification number0920408
Number of Individuals Covered470
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $175,606
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,338,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees175606
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-052464
Policy instance 2
Insurance contract or identification number010-052464
Number of Individuals Covered961
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $26,355
Total amount of fees paid to insurance companyUSD $8,745
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $263,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,355
Insurance broker organization code?3
Amount paid for insurance broker fees8745
Additional information about fees paid to insurance brokerSERVICE FEES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BN7J
Policy instance 3
Insurance contract or identification numberGLTD0BN7J
Number of Individuals Covered469
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,086
Total amount of fees paid to insurance companyUSD $7,212
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,086
Amount paid for insurance broker fees7212
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BN7J
Policy instance 4
Insurance contract or identification numberGLUG0BN7J
Number of Individuals Covered469
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,090
Total amount of fees paid to insurance companyUSD $1,431
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,090
Amount paid for insurance broker fees1431
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0BN7J
Policy instance 5
Insurance contract or identification numberGUG0BN7J
Number of Individuals Covered469
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $13,226
Total amount of fees paid to insurance companyUSD $5,704
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $88,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,226
Amount paid for insurance broker fees5704
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BN7J
Policy instance 6
Insurance contract or identification numberGVTL0BN7J
Number of Individuals Covered282
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,361
Total amount of fees paid to insurance companyUSD $7,242
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $94,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,361
Amount paid for insurance broker fees7242
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BN7J
Policy instance 6
Insurance contract or identification numberGVTL0BN7J
Number of Individuals Covered293
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $17,503
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,503
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0BN7J
Policy instance 5
Insurance contract or identification numberGUG0BN7J
Number of Individuals Covered457
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,904
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $84,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,904
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BN7J
Policy instance 4
Insurance contract or identification numberGLUG0BN7J
Number of Individuals Covered457
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,958
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,958
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BN7J
Policy instance 3
Insurance contract or identification numberGLTD0BN7J
Number of Individuals Covered457
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $21,638
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,638
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-052464
Policy instance 2
Insurance contract or identification number010-052464
Number of Individuals Covered948
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $26,411
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $268,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,111
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0920408
Policy instance 1
Insurance contract or identification number0920408
Number of Individuals Covered403
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $167,740
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,188,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees167740
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF023504
Policy instance 2
Insurance contract or identification numberVF023504
Number of Individuals Covered806
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,984
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $285,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,903
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number034130
Policy instance 1
Insurance contract or identification number034130
Number of Individuals Covered705
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $121,379
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,931,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91,224
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number034130
Policy instance 1
Insurance contract or identification number034130
Number of Individuals Covered421
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $95,648
Total amount of fees paid to insurance companyUSD $1,149
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,223,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,445
Insurance broker organization code?3
Amount paid for insurance broker fees1149
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-042928
Policy instance 2
Insurance contract or identification number010-042928
Number of Individuals Covered904
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,286
Total amount of fees paid to insurance companyUSD $580
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $152,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,498
Insurance broker organization code?3
Amount paid for insurance broker fees580
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 )
Policy contract number330870
Policy instance 3
Insurance contract or identification number330870
Number of Individuals Covered327
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,767
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,767
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD389046663601
Policy instance 4
Insurance contract or identification numberGD389046663601
Number of Individuals Covered428
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $16,677
Total amount of fees paid to insurance companyUSD $1,538
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $83,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,549
Insurance broker organization code?3
Amount paid for insurance broker fees513
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA389046663601
Policy instance 5
Insurance contract or identification numberSA389046663601
Number of Individuals Covered428
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $14,774
Total amount of fees paid to insurance companyUSD $1,398
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,054
Insurance broker organization code?3
Amount paid for insurance broker fees472
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF389046663601
Policy instance 6
Insurance contract or identification numberGF389046663601
Number of Individuals Covered428
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,750
Total amount of fees paid to insurance companyUSD $1,430
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,904
Insurance broker organization code?3
Amount paid for insurance broker fees485
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF389046663601
Policy instance 6
Insurance contract or identification numberGF389046663601
Number of Individuals Covered349
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,611
Total amount of fees paid to insurance companyUSD $1,977
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,200
Amount paid for insurance broker fees1977
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA389046663601
Policy instance 5
Insurance contract or identification numberSA389046663601
Number of Individuals Covered349
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,569
Total amount of fees paid to insurance companyUSD $1,988
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,235
Amount paid for insurance broker fees1988
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD389046663601
Policy instance 4
Insurance contract or identification numberGD389046663601
Number of Individuals Covered349
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $15,473
Total amount of fees paid to insurance companyUSD $2,070
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $77,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,551
Insurance broker organization code?3
Amount paid for insurance broker fees2070
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number330870
Policy instance 3
Insurance contract or identification number330870
Number of Individuals Covered500
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,598
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,598
Insurance broker organization code?3
Insurance broker nameBILL HARTSFIELD & ASSOCIATES
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-042928
Policy instance 2
Insurance contract or identification number010-042928
Number of Individuals Covered349
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,064
Total amount of fees paid to insurance companyUSD $1,493
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,734
Amount paid for insurance broker fees1493
Additional information about fees paid to insurance brokerADMINISTRATIVE FEE
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number34130
Policy instance 1
Insurance contract or identification number34130
Number of Individuals Covered369
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $93,717
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,998,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,113
Insurance broker organization code?3
Insurance broker nameBILL HARTSFIELD & ASSOCIATES

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