LEVI STRAUSS & CO. has sponsored the creation of one or more 401k plans.
Additional information about LEVI STRAUSS & CO.
Submission information for form 5500 for 401k plan LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES
401k plan membership statisitcs for LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES
| Measure | Date | Value |
|---|
| 2022: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 4,034 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 3,847 |
| Total of all active and inactive participants | 2022-01-01 | 3,847 |
| 2021: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 4,272 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 4,034 |
| Total of all active and inactive participants | 2021-01-01 | 4,034 |
| 2020: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 4,460 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 4,272 |
| Total of all active and inactive participants | 2020-01-01 | 4,272 |
| 2019: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 4,654 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 4,460 |
| Total of all active and inactive participants | 2019-01-01 | 4,460 |
| 2018: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 4,820 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 4,654 |
| Total of all active and inactive participants | 2018-01-01 | 4,654 |
| 2017: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 5,255 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 4,820 |
| Total of all active and inactive participants | 2017-01-01 | 4,820 |
| 2016: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 5,640 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 5,255 |
| Total of all active and inactive participants | 2016-01-01 | 5,255 |
| 2015: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 5,838 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 5,640 |
| Total of all active and inactive participants | 2015-01-01 | 5,640 |
| 2014: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 6,192 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 5,838 |
| Total of all active and inactive participants | 2014-01-01 | 5,838 |
| 2013: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-25 | 0 |
| Number of retired or separated participants receiving benefits | 2013-11-25 | 6,192 |
| Total of all active and inactive participants | 2013-11-25 | 6,192 |
| 2022: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | Yes |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: LEVI STRAUSS-LOCAL PAYROLL FACTORY AND CUSTOMER SERVICE CENTER RETIREES 2013 form 5500 responses |
|---|
| 2013-11-25 | Type of plan entity | Single employer plan |
| 2013-11-25 | First time form 5500 has been submitted | Yes |
| 2013-11-25 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2013-11-25 | Plan is a collectively bargained plan | Yes |
| 2013-11-25 | Plan funding arrangement – Insurance | Yes |
| 2013-11-25 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-25 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-25 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G | | Number of Individuals Covered | 3847 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $783,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 1 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G | | Number of Individuals Covered | 4034 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $716,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 1 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G | | Number of Individuals Covered | 4272 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $787,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 1 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,601 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 1 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0165675 |
| Policy instance | 2 |
| Insurance contract or identification number | 0165675 | | Number of Individuals Covered | 4460 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $42 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $799,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 42 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0165675 |
| Policy instance | 3 |
| Insurance contract or identification number | 0165675 | | Number of Individuals Covered | 4820 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $15,047 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $791,988 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 15000 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES AND | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 2 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $110,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | L01683 |
| Policy instance | 1 |
| Insurance contract or identification number | L01683 | | 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 $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 3 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | LO1683 |
| Policy instance | 2 |
| Insurance contract or identification number | LO1683 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 7653 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $637,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 7028 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $17,980 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $568,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 ) |
| Policy contract number | 20168300-1/9001 |
| Policy instance | 2 |
| Insurance contract or identification number | 20168300-1/9001 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $62,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | LO1683 |
| Policy instance | 3 |
| Insurance contract or identification number | LO1683 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 4 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 7028 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $17,980 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $568,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7590 | | Additional information about fees paid to insurance broker | GI 2014 BONUS RETENTION | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN BENEFITS & COMPENSATION |
|
| LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 ) |
| Policy contract number | 20168300-1/9001 |
| Policy instance | 2 |
| Insurance contract or identification number | 20168300-1/9001 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $62,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | LO1683 |
| Policy instance | 3 |
| Insurance contract or identification number | LO1683 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 20168300 |
| Policy instance | 4 |
| Insurance contract or identification number | 20168300 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LOVELACE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95808 ) |
| Policy contract number | 20168300-1/9001 |
| Policy instance | 2 |
| Insurance contract or identification number | 20168300-1/9001 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $218,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 8139 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $5,546 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $562,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5546 | | Additional information about fees paid to insurance broker | DENTAL & BONUS RETENTION | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN BENEFITS & COMPENSATION |
|
