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BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 401k Plan overview

Plan NameBI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN
Plan identification number 512

BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

BRINKER INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:BRINKER INTERNATIONAL, INC.
Employer identification number (EIN):751914582
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Additional information about BRINKER INTERNATIONAL, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1992-07-09
Company Identification Number: 0009205106
Legal Registered Office Address: 3000 OLYMPUS BLVD ATTN: TAX DEPT

COPPELL
United States of America (USA)
75019

More information about BRINKER INTERNATIONAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5122022-01-01JASON MANSFIELD2023-07-31
5122021-01-01JASON MANSFIELD2022-07-27 JASON MANSFIELD2022-07-27
5122020-01-01JASON MANSFIELD2021-07-28 JASON MANSFIELD2021-07-28
5122019-01-01
5122018-01-01
5122017-01-01CHRIS GAITHER
5122016-01-01JOSH LIPSCOMB
5122015-01-01VIRGINIA NISBET
5122014-01-01VIRGINIA NISBET
5122013-01-01VIRGINIA NISBET
5122012-01-01VIRGINIA NISBET VIRGINIA NISBET2013-09-06
5122011-01-01VIRGINIA NISBET VIRGINIA NISBET2013-09-06

Plan Statistics for BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN

401k plan membership statisitcs for BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN

Measure Date Value
2022: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,646
Total number of active participants reported on line 7a of the Form 55002022-01-011,424
Number of retired or separated participants receiving benefits2022-01-0133
Total of all active and inactive participants2022-01-011,457
Total participants2022-01-011,457
2021: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,117
Total number of active participants reported on line 7a of the Form 55002021-01-011,293
Number of retired or separated participants receiving benefits2021-01-0131
Total of all active and inactive participants2021-01-011,324
Total participants2021-01-011,324
2020: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,703
Total number of active participants reported on line 7a of the Form 55002020-01-011,130
Number of retired or separated participants receiving benefits2020-01-0123
Total of all active and inactive participants2020-01-011,153
Total participants2020-01-011,153
2019: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,740
Total number of active participants reported on line 7a of the Form 55002019-01-011,682
Number of retired or separated participants receiving benefits2019-01-0121
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,703
2018: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,027
Total number of active participants reported on line 7a of the Form 55002018-01-011,740
Number of retired or separated participants receiving benefits2018-01-0133
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,773
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-011,773
2017: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,137
Total number of active participants reported on line 7a of the Form 55002017-01-012,003
Number of retired or separated participants receiving benefits2017-01-0124
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-012,027
2016: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012,057
Total number of active participants reported on line 7a of the Form 55002016-01-011,288
Number of retired or separated participants receiving benefits2016-01-0119
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,307
2015: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-012,296
Total number of active participants reported on line 7a of the Form 55002015-01-011,381
Number of retired or separated participants receiving benefits2015-01-0138
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,419
2014: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,819
Total number of active participants reported on line 7a of the Form 55002014-01-011,511
Number of retired or separated participants receiving benefits2014-01-0136
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,547
2013: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013,205
Total number of active participants reported on line 7a of the Form 55002013-01-012,048
Number of retired or separated participants receiving benefits2013-01-0144
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-012,092
2012: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-013,658
Total number of active participants reported on line 7a of the Form 55002012-01-013,152
Number of retired or separated participants receiving benefits2012-01-0153
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-013,205
2011: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-014,196
Total number of active participants reported on line 7a of the Form 55002011-01-012,931
Number of retired or separated participants receiving benefits2011-01-0177
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-013,008

Form 5500 Responses for BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN

2022: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: BI PAYROLL COMPANY PART TIME EMPLOYEE HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered1424
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,891
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,615,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,891
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered1293
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $151,479
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,432,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,992
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered1130
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $145,990
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,579,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $136,916
Insurance broker organization code?3
PRAM INSURANCE (National Association of Insurance Commissioners NAIC id number: 12747 )
Policy contract number720122
Policy instance 2
Insurance contract or identification number720122
Number of Individuals Covered1682
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,607
Welfare Benefit Premiums Paid to CarrierUSD $32,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,607
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered1682
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $179,202
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,931,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $167,995
Insurance broker organization code?3
PRAM INSURANCE (National Association of Insurance Commissioners NAIC id number: 12747 )
Policy contract number720122
Policy instance 2
Insurance contract or identification number720122
Number of Individuals Covered2254
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,561
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $31,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,561
Insurance broker organization code?3
Insurance broker nameFRINGE INSURANCE BENEFITS, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered2254
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $190,966
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,078,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $179,124
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOC. - DALLAS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number720122
Policy instance 2
Insurance contract or identification number720122
Number of Individuals Covered2505
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,155
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $23,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,155
Insurance broker organization code?3
Insurance broker nameFRINGE INSURANCE BENEFITS, INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered2505
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $181,703
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,978,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $170,464
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered2765
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $216,627
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,359,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $172,744
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered2749
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $302,513
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,278,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $207,382
Insurance broker organization code?3
Insurance broker nameHOLMES & MURPHY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered3152
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $364,777
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,018,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $250,318
Insurance broker organization code?3
Insurance broker nameHOLMES & MURPHY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered2931
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $556,498
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,662,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberFV1130
Policy instance 1
Insurance contract or identification numberFV1130
Number of Individuals Covered3555
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $773,647
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,549,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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