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BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 401k Plan overview

Plan NameBROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN
Plan identification number 503

BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

BROOKSHIRE BROTHERS INC has sponsored the creation of one or more 401k plans.

Company Name:BROOKSHIRE BROTHERS INC
Employer identification number (EIN):752692839
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-05-01
5032021-05-01
5032020-05-01
5032019-05-01
5032018-05-01
5032017-05-01CLAY OLIVER
5032016-05-01CLAY OLIVER
5032015-05-01CLAY OLIVER
5032014-05-01CLAY OLIVER
5032013-05-01CLAY OLIVER
5032012-05-01CLAY OLIVER
5032011-05-01CLAY OLIVER
5032010-05-01CLAY OLIVER
5032009-05-01JERRY JOHNSON

Plan Statistics for BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN

401k plan membership statisitcs for BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN

Measure Date Value
2022: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-011,024
Total number of active participants reported on line 7a of the Form 55002022-05-01932
Total of all active and inactive participants2022-05-01932
Total participants2022-05-01932
2021: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-011,089
Total number of active participants reported on line 7a of the Form 55002021-05-011,024
Total of all active and inactive participants2021-05-011,024
Total participants2021-05-011,024
2020: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-011,044
Total number of active participants reported on line 7a of the Form 55002020-05-011,089
Total of all active and inactive participants2020-05-011,089
Total participants2020-05-011,089
2019: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-011,092
Total number of active participants reported on line 7a of the Form 55002019-05-011,044
Total of all active and inactive participants2019-05-011,044
Total participants2019-05-011,044
2018: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-011,197
Total number of active participants reported on line 7a of the Form 55002018-05-011,092
Total of all active and inactive participants2018-05-011,092
Total participants2018-05-011,092
2017: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-011,212
Total number of active participants reported on line 7a of the Form 55002017-05-011,197
Total of all active and inactive participants2017-05-011,197
Total participants2017-05-011,197
2016: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-011,241
Total number of active participants reported on line 7a of the Form 55002016-05-011,212
Total of all active and inactive participants2016-05-011,212
Total participants2016-05-011,212
2015: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-011,180
Total number of active participants reported on line 7a of the Form 55002015-05-011,241
Total of all active and inactive participants2015-05-011,241
Total participants2015-05-011,241
2014: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-011,103
Total number of active participants reported on line 7a of the Form 55002014-05-011,180
Total of all active and inactive participants2014-05-011,180
Total participants2014-05-011,180
2013: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-011,076
Total number of active participants reported on line 7a of the Form 55002013-05-011,103
Total of all active and inactive participants2013-05-011,103
Total participants2013-05-011,103
2012: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-011,105
Total number of active participants reported on line 7a of the Form 55002012-05-011,076
Total of all active and inactive participants2012-05-011,076
Total participants2012-05-011,076
2011: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-011,114
Total number of active participants reported on line 7a of the Form 55002011-05-011,105
Total of all active and inactive participants2011-05-011,105
Total participants2011-05-011,105
2010: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-011,249
Total number of active participants reported on line 7a of the Form 55002010-05-011,114
Total of all active and inactive participants2010-05-011,114
Total participants2010-05-011,114
2009: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-011,253
Total number of active participants reported on line 7a of the Form 55002009-05-011,249
Total of all active and inactive participants2009-05-011,249
Total participants2009-05-011,249

Form 5500 Responses for BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN

2022: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingYes
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – General assets of the sponsorYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – General assets of the sponsorYes
2020: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – General assets of the sponsorYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – General assets of the sponsorYes
2019: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – General assets of the sponsorYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – General assets of the sponsorYes
2018: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – General assets of the sponsorYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – General assets of the sponsorYes
2017: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – General assets of the sponsorYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – General assets of the sponsorYes
2016: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – General assets of the sponsorYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – General assets of the sponsorYes
2015: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – General assets of the sponsorYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – General assets of the sponsorYes
2014: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – General assets of the sponsorYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – General assets of the sponsorYes
2013: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – General assets of the sponsorYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – General assets of the sponsorYes
2012: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – General assets of the sponsorYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – General assets of the sponsorYes
2011: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – General assets of the sponsorYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – General assets of the sponsorYes
2010: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Plan funding arrangement – General assets of the sponsorYes
2010-05-01Plan benefit arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – General assets of the sponsorYes
2009: BROOKSHIRE BROTHERS INC EMPLOYEE HEALTH AND DENTAL PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Plan funding arrangement – General assets of the sponsorYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1024
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $36,762
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 $206,523
Commission paid to Insurance BrokerUSD $36,762
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1089
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $42,559
Total amount of fees paid to insurance companyUSD $298,935
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 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 $186,320
Commission paid to Insurance BrokerUSD $42,559
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1044
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $36,898
Total amount of fees paid to insurance companyUSD $291,195
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 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 $245,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,898
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1092
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $38,905
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 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 $258,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,905
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1197
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $104,472
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 $270,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,104
Insurance broker organization code?3
Insurance broker nameBBC OF EAST TEXAS
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1241
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $111,705
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 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 $306,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,013
Insurance broker organization code?3
Insurance broker nameMSLM INSURANCE MARKETING
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Number of Individuals Covered1180
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $102,237
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 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 $267,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,386
Insurance broker organization code?3
Insurance broker nameBBC OF EAST TEXAS
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $91,044
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 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 $247,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,456
Insurance broker organization code?3
Insurance broker nameMSLM INSURANCE MARKETING
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19672
Policy instance 1
Insurance contract or identification numberHCL19672
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $93,442
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 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 $258,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,695
Insurance broker organization code?3
Insurance broker nameBBC OF EAST TEXAS
PERICO LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85561 )
Policy contract number
Policy instance 1
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $101,153
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $265,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PERICO LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85561 )
Policy contract number
Policy instance 1
Number of Individuals Covered1114
Total amount of commissions paid to insurance brokerUSD $62,069
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $272,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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