401k Plan data: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN plan

MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 401k Plan overview

Plan Name	MENHOLT AUTOMOTIVE GROUP HEALTH PLAN
Plan identification number	501

MENHOLT AUTOMOTIVE GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare 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

MENHOLT AUTOMOTIVE GROUP has sponsored the creation of one or more 401k plans.

Company Name: MENHOLT AUTOMOTIVE GROUP

Employer identification number (EIN): 810449357

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENHOLT AUTOMOTIVE GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 SUSAN SCHLOSS
501 2017-01-01 SUSAN SCHLOSS
501 2016-01-01 SUSAN SCHLOSS
501 2015-01-01 SUSAN SCHLOSS
501 2014-01-01 SUSAN SCHLOSS
501 2013-01-01 SUSAN SCHLOSS SUSAN SCHLOSS 2017-01-10

Plan Statistics for MENHOLT AUTOMOTIVE GROUP HEALTH PLAN

401k plan membership statisitcs for MENHOLT AUTOMOTIVE GROUP HEALTH PLAN

Measure Date Value
2022: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 519
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 455
Total of all active and inactive participants 2022-01-01 455
2021: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 488
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 519
Total of all active and inactive participants 2021-01-01 519
2020: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 497
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 488
Total of all active and inactive participants 2020-01-01 488
2019: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 497
Total of all active and inactive participants 2019-01-01 497
2018: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 304
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 361
Total of all active and inactive participants 2018-01-01 361
2017: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 401
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 304
Total of all active and inactive participants 2017-01-01 304
2016: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 401
Total of all active and inactive participants 2016-01-01 401
2015: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 341
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 361
Total of all active and inactive participants 2015-01-01 361
2014: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 341
Total of all active and inactive participants 2014-01-01 341
2013: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 207
Total of all active and inactive participants 2013-01-01 207

Measure	Date	Value
2022: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	519
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	455
Total of all active and inactive participants	2022-01-01	455
2021: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	488
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	519
Total of all active and inactive participants	2021-01-01	519
2020: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	497
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	488
Total of all active and inactive participants	2020-01-01	488
2019: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	497
Total of all active and inactive participants	2019-01-01	497
2018: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	304
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	361
Total of all active and inactive participants	2018-01-01	361
2017: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	401
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	304
Total of all active and inactive participants	2017-01-01	304
2016: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	401
Total of all active and inactive participants	2016-01-01	401
2015: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	341
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	361
Total of all active and inactive participants	2015-01-01	361
2014: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	341
Total of all active and inactive participants	2014-01-01	341
2013: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	207
Total of all active and inactive participants	2013-01-01	207

Form 5500 Responses for MENHOLT AUTOMOTIVE GROUP HEALTH PLAN

2022: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MENHOLT AUTOMOTIVE GROUP HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	432
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $32,601
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $288,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,601
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0HVM6

Policy instance

Insurance contract or identification number	0HVM6
Number of Individuals Covered	52
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,840
Total amount of fees paid to insurance company	USD $21
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $848
Insurance broker organization code?	3
Amount paid for insurance broker fees	15

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V1090

Policy instance

Insurance contract or identification number	V1090
Number of Individuals Covered	10
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $848
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $7,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $346
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	4
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $296
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $209
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	15
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,409
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $13,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $771
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

235448

Policy instance

Insurance contract or identification number	235448
Number of Individuals Covered	455
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $88,219
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,948,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,219
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	180
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $23,403
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $105,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,353
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	447
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $33,798
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $298,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,798
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	519
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,129
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $88,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,574
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V1090

Policy instance

Insurance contract or identification number	V1090
Number of Individuals Covered	11
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,046
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $9,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $406
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	15
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,563
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $14,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $791
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	4
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $271
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $192
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	3
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $391
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $317
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0HVM6

Policy instance

Insurance contract or identification number	0HVM6
Number of Individuals Covered	58
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,766
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $41,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

235448

Policy instance

Insurance contract or identification number	235448
Number of Individuals Covered	490
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $83,799
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,810,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,799
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

235448

Policy instance

Insurance contract or identification number	235448
Number of Individuals Covered	488
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $81,856
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,732,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,856
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V1090

Policy instance

Insurance contract or identification number	V1090
Number of Individuals Covered	15
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,169
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $10,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $465
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $346
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $296
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $209
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,960
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $17,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $974
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	460
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27,540
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $243,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,540
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	472
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,180
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $98,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,862
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0HVM6

Policy instance

Insurance contract or identification number	0HVM6
Number of Individuals Covered	64
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,406
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $48,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,257
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

235448

Policy instance

Insurance contract or identification number	235448
Number of Individuals Covered	497
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $81,011
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,701,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,011
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	441
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $21,153
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $78,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,651
Insurance broker organization code?	3
Amount paid for insurance broker fees	0

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	440
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $31,010
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $275,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,010
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	19
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,798
Total amount of fees paid to insurance company	USD $99
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $21,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,197
Insurance broker organization code?	3
Amount paid for insurance broker fees	85

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $346
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	4
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $487
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $262
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V1090

Policy instance

Insurance contract or identification number	V1090
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,359
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $12,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $588
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0HVM6

Policy instance

Insurance contract or identification number	0HVM6
Number of Individuals Covered	66
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,705
Total amount of fees paid to insurance company	USD $245
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $56,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,768
Amount paid for insurance broker fees	117
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	361
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,348
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $67,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,760
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	298
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,500
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $153,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,500
Insurance broker organization code?	3

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0036240

Policy instance

Insurance contract or identification number	G0036240
Number of Individuals Covered	339
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $48,006
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,670,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,006
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	22
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,512
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,235
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	8
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $606
Total amount of fees paid to insurance company	USD $61
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $300
Insurance broker organization code?	3
Amount paid for insurance broker fees	43

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $591
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $481
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V1090

Policy instance

Insurance contract or identification number	V1090
Number of Individuals Covered	13
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,313
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $590
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00496230

Policy instance

Insurance contract or identification number	00496230
Number of Individuals Covered	303
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $20,400
Total amount of fees paid to insurance company	USD $8,980
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, OPTIONAL LIFE, OPTIONAL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $192,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,948
Amount paid for insurance broker fees	8980
Insurance broker organization code?	3
Insurance broker name	MIRIAM AVERY INSURANCE AGENCY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

B9B80

Policy instance

Insurance contract or identification number	B9B80
Number of Individuals Covered	21
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,846
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,659
Insurance broker organization code?	3
Insurance broker name	CASEY DALE HOBSON

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

HFK39

Policy instance

Insurance contract or identification number	HFK39
Number of Individuals Covered	11
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,421
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $12,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,142
Insurance broker organization code?	3
Insurance broker name	MARCI MARIE OTIS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G0F26

Policy instance

Insurance contract or identification number	G0F26
Number of Individuals Covered	5
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $692
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $563
Insurance broker organization code?	3
Insurance broker name	DAWN D SHEUE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ESH42

Policy instance

Insurance contract or identification number	ESH42
Number of Individuals Covered	7
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $589
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $338
Insurance broker organization code?	3
Insurance broker name	DAWN D SHEUE

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0036240

Policy instance

Insurance contract or identification number	G0036240
Number of Individuals Covered	340
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $35,222
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,823,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,376
Insurance broker organization code?	3
Insurance broker name	HOWARD J STAGG

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000007827

Policy instance

Insurance contract or identification number	0000007827
Number of Individuals Covered	304
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $20,816
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $66,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,327
Insurance broker organization code?	3
Amount paid for insurance broker fees	0
Insurance broker name	KEEFE P BURCHER

Potentially related plans

MENHOLT AUTOMOTIVE GROUP HEALTH PLAN [EIN = 204419990]

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Company Name:	MENHOLT AUTOMOTIVE GROUP
Employer identification number (EIN):	810449357
NAIC Classification:	441110
NAIC Description:	New Car Dealers