BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN
401k plan membership statisitcs for BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2021 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $1,278,438 |
| Total of all expenses incurred | 2021-12-31 | $1,278,438 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $1,190,429 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $1,278,438 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $88,009 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $380,122 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $65,156 |
| Administrative expenses (other) incurred | 2021-12-31 | $30,800 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $307,191 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $833,160 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $883,238 |
| Contract administrator fees | 2021-12-31 | $57,209 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | Yes |
| 2020 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-12-31 | $1,211,849 |
| Total of all expenses incurred | 2020-12-31 | $1,211,849 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $1,123,415 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $1,211,849 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $88,434 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $376,716 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $4,737 |
| Administrative expenses (other) incurred | 2020-12-31 | $30,925 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $321,158 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $830,396 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $802,257 |
| Contract administrator fees | 2020-12-31 | $57,509 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | Yes |
| 2019 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $1,173,671 |
| Total of all expenses incurred | 2019-12-31 | $1,173,671 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $1,086,918 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $1,173,671 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $86,753 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $349,010 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $144,525 |
| Administrative expenses (other) incurred | 2019-12-31 | $30,375 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $380,309 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $680,136 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $706,609 |
| Contract administrator fees | 2019-12-31 | $56,378 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | Yes |
| 2017 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-12-31 | $1,212,497 |
| Total of all expenses incurred | 2017-12-31 | $1,212,497 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $1,165,518 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $1,212,497 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $46,979 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Was this plan covered by a fidelity bond | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $416,091 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $143,307 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $326,437 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $653,099 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $839,081 |
| Contract administrator fees | 2017-12-31 | $46,979 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | Yes |
| 2016 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-12-31 | $1,558,846 |
| Total of all expenses incurred | 2016-12-31 | $1,558,846 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $1,460,610 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $1,558,846 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $98,236 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $266,188 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-12-31 | $429,411 |
| Administrative expenses (other) incurred | 2016-12-31 | $44,537 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $295,270 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $863,247 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $1,165,340 |
| Contract administrator fees | 2016-12-31 | $53,699 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | Yes |
| 2015 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $830,316 |
| Total of all expenses incurred | 2015-12-31 | $830,316 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $740,034 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $830,316 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $90,282 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $168,039 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-12-31 | $11,037 |
| Administrative expenses (other) incurred | 2015-12-31 | $44,533 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $231,020 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $651,240 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $509,014 |
| Contract administrator fees | 2015-12-31 | $45,749 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | Yes |
| 2014 : BUDWEISER DISTRIBUTING COMPANY OF BORGER, LP HEALTH BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $409,516 |
| Total of all expenses incurred | 2014-12-31 | $409,516 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $363,392 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $409,516 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $46,124 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $106,731 |
| Administrative expenses (other) incurred | 2014-12-31 | $19,866 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $90,689 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $302,785 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $272,703 |
| Contract administrator fees | 2014-12-31 | $26,258 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | Yes |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S729808 |
| Policy instance | 3 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $225,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA389046700501 |
| Policy instance | 2 |
| Insurance contract or identification number | SA389046700501 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $13,634 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,634 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40380 |
| Policy instance | 1 |
| Insurance contract or identification number | HCCLOT40380 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $652 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $13,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $652 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S729808 |
| Policy instance | 3 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $239,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA389046700501 |
| Policy instance | 2 |
| Insurance contract or identification number | SA389046700501 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $13,215 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,215 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40380 |
| Policy instance | 1 |
| Insurance contract or identification number | HCCLOT40380 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $657 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $13,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $657 | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S729808 |
| Policy instance | 4 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $206,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA389046700501 |
| Policy instance | 3 |
| Insurance contract or identification number | SA389046700501 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $16,677 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,677 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40380 |
| Policy instance | 2 |
| Insurance contract or identification number | HCCLOT40380 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $613 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $12,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $613 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010046722 |
| Policy instance | 1 |
| Insurance contract or identification number | 010046722 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,781 | | Total amount of fees paid to insurance company | USD $315 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,781 | | Amount paid for insurance broker fees | 315 | | Additional information about fees paid to insurance broker | ADMIN | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30004251 |
| Policy instance | 5 |
| Insurance contract or identification number | 30004251 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,010 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,010 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA389046698001 |
| Policy instance | 4 |
| Insurance contract or identification number | SA389046698001 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,364 | | Total amount of fees paid to insurance company | USD $473 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,364 | | Amount paid for insurance broker fees | 473 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 34C061 |
| Policy instance | 3 |
| Insurance contract or identification number | 34C061 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-03-31 | | Total amount of commissions paid to insurance broker | USD $2,151 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,151 | | Insurance broker organization code? | 3 | | Insurance broker name | UPSHAW INSURANCE AGENCY |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | S729808 |
| Policy instance | 2 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $33,857 | | Total amount of fees paid to insurance company | USD $31,484 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $261,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,857 | | Amount paid for insurance broker fees | 17655 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-4358 |
| Policy instance | 1 |
| Insurance contract or identification number | 947-4358 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $541 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $10,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 541 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | STHEALTH BENEFIT SOLUTIONS LLC |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | S729808 |
| Policy instance | 2 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $10,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | S729808 |
| Policy instance | 1 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $50,565 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 38429 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 4 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | S729808 |
| Policy instance | 2 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $5,181 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | S729808 |
| Policy instance | 1 |
| Insurance contract or identification number | S729808 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,108 | | Total amount of fees paid to insurance company | USD $25,799 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,728 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,108 | | Amount paid for insurance broker fees | 19690 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 4 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
|
