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CAPFORM, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameCAPFORM, INC. HEALTH AND WELFARE PLAN
Plan identification number 502

CAPFORM, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

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

    Company Name:CAPFORM, INC.
    Employer identification number (EIN):751677890
    NAIC Classification:238900

    Additional information about CAPFORM, INC.

    Jurisdiction of Incorporation: Texas Secretary of State
    Incorporation Date: 1979-12-17
    Company Identification Number: 0050085700
    Legal Registered Office Address: PO BOX 111130

    CARROLLTON
    United States of America (USA)
    75011

    More information about CAPFORM, INC.

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan CAPFORM, INC. HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5022016-06-01GLORIA WADE
    5022015-06-01GLORIA WADE
    5022014-06-01GLORIA WADE
    5022013-06-01GLORIA WADE
    5022012-06-01GLORIA WADE
    5022011-06-01GLORIA WADE
    5022010-06-01GLORIA WADE
    5022009-06-01GLORIA WADE
    5022008-06-01GLORIA WADE
    5022007-06-01GLORIA WADE
    5022006-06-01GLORIA WADE
    5022005-06-01GLORIA WADE
    5022004-06-01GLORIA WADE
    5022003-06-01GLORIA WADE
    5022002-06-01GLORIA WADE
    5022002-06-01GLORIA WADE

    Plan Statistics for CAPFORM, INC. HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for CAPFORM, INC. HEALTH AND WELFARE PLAN

    Measure Date Value
    2016
    Total participants, beginning-of-year2016-06-011,400
    Total number of active participants reported on line 7a of the Form 55002016-06-011,658
    Number of retired or separated participants receiving benefits2016-06-014
    Number of other retired or separated participants entitled to future benefits2016-06-010
    Total of all active and inactive participants2016-06-011,662
    2015
    Total participants, beginning-of-year2015-06-01949
    Total number of active participants reported on line 7a of the Form 55002015-06-011,400
    Number of retired or separated participants receiving benefits2015-06-012
    Number of other retired or separated participants entitled to future benefits2015-06-010
    Total of all active and inactive participants2015-06-011,402
    2014
    Total participants, beginning-of-year2014-06-01348
    Total number of active participants reported on line 7a of the Form 55002014-06-01949
    Number of retired or separated participants receiving benefits2014-06-011
    Number of other retired or separated participants entitled to future benefits2014-06-010
    Total of all active and inactive participants2014-06-01950
    2013
    Total participants, beginning-of-year2013-06-01378
    Total number of active participants reported on line 7a of the Form 55002013-06-01361
    Number of retired or separated participants receiving benefits2013-06-010
    Number of other retired or separated participants entitled to future benefits2013-06-010
    Total of all active and inactive participants2013-06-01361
    2012
    Total participants, beginning-of-year2012-06-01310
    Total number of active participants reported on line 7a of the Form 55002012-06-01378
    Number of retired or separated participants receiving benefits2012-06-010
    Number of other retired or separated participants entitled to future benefits2012-06-010
    Total of all active and inactive participants2012-06-01378
    2011
    Total participants, beginning-of-year2011-06-01505
    Total number of active participants reported on line 7a of the Form 55002011-06-01310
    Number of retired or separated participants receiving benefits2011-06-010
    Number of other retired or separated participants entitled to future benefits2011-06-010
    Total of all active and inactive participants2011-06-01310
    2010
    Total participants, beginning-of-year2010-06-01418
    Total number of active participants reported on line 7a of the Form 55002010-06-01505
    Number of retired or separated participants receiving benefits2010-06-010
    Number of other retired or separated participants entitled to future benefits2010-06-010
    Total of all active and inactive participants2010-06-01505
    2009
    Total participants, beginning-of-year2009-06-01679
    Total number of active participants reported on line 7a of the Form 55002009-06-01418
    Number of retired or separated participants receiving benefits2009-06-010
    Number of other retired or separated participants entitled to future benefits2009-06-010
    Total of all active and inactive participants2009-06-01418
    2008
    Total participants, beginning-of-year2008-06-01802
    Total number of active participants reported on line 7a of the Form 55002008-06-01679
    Number of retired or separated participants receiving benefits2008-06-010
    Number of other retired or separated participants entitled to future benefits2008-06-010
    Total of all active and inactive participants2008-06-01679
    2007
    Total participants, beginning-of-year2007-06-01825
    Total number of active participants reported on line 7a of the Form 55002007-06-01802
    Number of retired or separated participants receiving benefits2007-06-010
    Number of other retired or separated participants entitled to future benefits2007-06-010
    Total of all active and inactive participants2007-06-01802
    2006
    Total participants, beginning-of-year2006-06-01290
    Total number of active participants reported on line 7a of the Form 55002006-06-01825
    Number of retired or separated participants receiving benefits2006-06-010
    Number of other retired or separated participants entitled to future benefits2006-06-010
    Total of all active and inactive participants2006-06-01825
    2005
    Total participants, beginning-of-year2005-06-01290
    Total number of active participants reported on line 7a of the Form 55002005-06-01290
    Number of retired or separated participants receiving benefits2005-06-010
    Number of other retired or separated participants entitled to future benefits2005-06-010
    Total of all active and inactive participants2005-06-01290
    2004
    Total participants, beginning-of-year2004-06-01290
    Total number of active participants reported on line 7a of the Form 55002004-06-01290
    Number of retired or separated participants receiving benefits2004-06-010
    Number of other retired or separated participants entitled to future benefits2004-06-010
    Total of all active and inactive participants2004-06-01290
    2003
    Total participants, beginning-of-year2003-06-01269
    Total number of active participants reported on line 7a of the Form 55002003-06-01290
    Number of retired or separated participants receiving benefits2003-06-010
    Number of other retired or separated participants entitled to future benefits2003-06-010
    Total of all active and inactive participants2003-06-01290
    2002
    Total participants, beginning-of-year2002-06-01100
    Total number of active participants reported on line 7a of the Form 55002002-06-01269
    Number of retired or separated participants receiving benefits2002-06-010
    Number of other retired or separated participants entitled to future benefits2002-06-010
    Total of all active and inactive participants2002-06-01269

    Form 5500 Responses

    2016
    2016-06-01Type of plan entitySingle employer plan
    2016-06-01Submission has been amendedNo
    2016-06-01This submission is the final filingNo
    2016-06-01This return/report is a short plan year return/report (less than 12 months)Yes
    2016-06-01Plan is a collectively bargained planNo
    2016-06-01Plan funding arrangement – InsuranceYes
    2016-06-01Plan benefit arrangement – InsuranceYes
    2015
    2015-06-01Type of plan entitySingle employer plan
    2015-06-01Submission has been amendedNo
    2015-06-01This submission is the final filingNo
    2015-06-01This return/report is a short plan year return/report (less than 12 months)No
    2015-06-01Plan is a collectively bargained planNo
    2015-06-01Plan funding arrangement – InsuranceYes
    2015-06-01Plan benefit arrangement – InsuranceYes
    2014
    2014-06-01Type of plan entitySingle employer plan
    2014-06-01Submission has been amendedNo
    2014-06-01This submission is the final filingNo
    2014-06-01This return/report is a short plan year return/report (less than 12 months)No
    2014-06-01Plan is a collectively bargained planNo
    2014-06-01Plan funding arrangement – InsuranceYes
    2014-06-01Plan benefit arrangement – InsuranceYes
    2013
    2013-06-01Type of plan entitySingle employer plan
    2013-06-01Submission has been amendedNo
    2013-06-01This submission is the final filingNo
    2013-06-01This return/report is a short plan year return/report (less than 12 months)No
    2013-06-01Plan is a collectively bargained planNo
    2013-06-01Plan funding arrangement – InsuranceYes
    2013-06-01Plan benefit arrangement – InsuranceYes
    2012
    2012-06-01Type of plan entitySingle employer plan
    2012-06-01Submission has been amendedNo
    2012-06-01This submission is the final filingNo
    2012-06-01This return/report is a short plan year return/report (less than 12 months)No
    2012-06-01Plan is a collectively bargained planNo
    2012-06-01Plan funding arrangement – InsuranceYes
    2012-06-01Plan benefit arrangement – InsuranceYes
    2011
    2011-06-01Type of plan entitySingle employer plan
    2011-06-01Submission has been amendedNo
    2011-06-01This submission is the final filingNo
    2011-06-01This return/report is a short plan year return/report (less than 12 months)No
    2011-06-01Plan is a collectively bargained planNo
    2011-06-01Plan funding arrangement – InsuranceYes
    2011-06-01Plan benefit arrangement – InsuranceYes
    2010
    2010-06-01Type of plan entitySingle employer plan
    2010-06-01Submission has been amendedNo
    2010-06-01This submission is the final filingNo
    2010-06-01This return/report is a short plan year return/report (less than 12 months)No
    2010-06-01Plan is a collectively bargained planNo
    2010-06-01Plan funding arrangement – InsuranceYes
    2010-06-01Plan benefit arrangement – InsuranceYes
    2009
    2009-06-01Type of plan entitySingle employer plan
    2009-06-01Submission has been amendedNo
    2009-06-01This submission is the final filingNo
    2009-06-01This return/report is a short plan year return/report (less than 12 months)No
    2009-06-01Plan is a collectively bargained planNo
    2009-06-01Plan funding arrangement – InsuranceYes
    2009-06-01Plan benefit arrangement – InsuranceYes
    2008
    2008-06-01Type of plan entitySingle employer plan
    2008-06-01Submission has been amendedNo
    2008-06-01This submission is the final filingNo
    2008-06-01This return/report is a short plan year return/report (less than 12 months)No
    2008-06-01Plan is a collectively bargained planNo
    2008-06-01Plan funding arrangement – InsuranceYes
    2008-06-01Plan benefit arrangement – InsuranceYes
    2007
    2007-06-01Type of plan entitySingle employer plan
    2007-06-01Submission has been amendedNo
    2007-06-01This submission is the final filingNo
    2007-06-01This return/report is a short plan year return/report (less than 12 months)No
    2007-06-01Plan is a collectively bargained planNo
    2007-06-01Plan funding arrangement – InsuranceYes
    2007-06-01Plan benefit arrangement – InsuranceYes
    2006
    2006-06-01Type of plan entitySingle employer plan
    2006-06-01Submission has been amendedNo
    2006-06-01This submission is the final filingNo
    2006-06-01This return/report is a short plan year return/report (less than 12 months)No
    2006-06-01Plan is a collectively bargained planNo
    2006-06-01Plan funding arrangement – InsuranceYes
    2006-06-01Plan benefit arrangement – InsuranceYes
    2005
    2005-06-01Type of plan entitySingle employer plan
    2005-06-01Submission has been amendedNo
    2005-06-01This submission is the final filingNo
    2005-06-01This return/report is a short plan year return/report (less than 12 months)No
    2005-06-01Plan is a collectively bargained planNo
    2005-06-01Plan funding arrangement – InsuranceYes
    2005-06-01Plan benefit arrangement – InsuranceYes
    2004
    2004-06-01Type of plan entitySingle employer plan
    2004-06-01Submission has been amendedNo
    2004-06-01This submission is the final filingNo
    2004-06-01This return/report is a short plan year return/report (less than 12 months)No
    2004-06-01Plan is a collectively bargained planNo
    2004-06-01Plan funding arrangement – InsuranceYes
    2004-06-01Plan benefit arrangement – InsuranceYes
    2003
    2003-06-01Type of plan entitySingle employer plan
    2003-06-01Submission has been amendedNo
    2003-06-01This submission is the final filingNo
    2003-06-01This return/report is a short plan year return/report (less than 12 months)No
    2003-06-01Plan is a collectively bargained planNo
    2003-06-01Plan funding arrangement – InsuranceYes
    2003-06-01Plan benefit arrangement – InsuranceYes
    2002
    2002-06-01Type of plan entitySingle employer plan
    2002-06-01First time form 5500 has been submittedYes
    2002-06-01Submission has been amendedNo
    2002-06-01This submission is the final filingNo
    2002-06-01This return/report is a short plan year return/report (less than 12 months)No
    2002-06-01Plan is a collectively bargained planNo
    2002-06-01Plan funding arrangement – InsuranceYes
    2002-06-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract number77805
    Policy instance 1
    Insurance contract or identification number77805
    Number of Individuals Covered1803
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $165,427
    Total amount of fees paid to insurance companyUSD $2,932
    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 $3,368,293
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $165,427
    Amount paid for insurance broker fees368
    Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameALKALI, LLC
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract number77805
    Policy instance 1
    Insurance contract or identification number77805
    Number of Individuals Covered929
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $96,260
    Total amount of fees paid to insurance companyUSD $72
    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 $1,984,800
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $48,386
    Insurance broker organization code?3
    Amount paid for insurance broker fees36
    Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
    Insurance broker nameALKALI, LLC
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract number77805
    Policy instance 1
    Insurance contract or identification number77805
    Number of Individuals Covered361
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $27,354
    Total amount of fees paid to insurance companyUSD $3,744
    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 $557,763
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $17,780
    Amount paid for insurance broker fees3744
    Additional information about fees paid to insurance brokerBONUS SPECIAL PROGRAMS
    Insurance broker organization code?3
    Insurance broker nameALKALI, LLC
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract number77805
    Policy instance 1
    Insurance contract or identification number77805
    Number of Individuals Covered378
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $27,004
    Total amount of fees paid to insurance companyUSD $6,585
    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 $541,513
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $27,004
    Amount paid for insurance broker fees6585
    Additional information about fees paid to insurance brokerBONUS SPECIAL PROGRAMS
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
    Policy contract number77805
    Policy instance 1
    Insurance contract or identification number77805
    Number of Individuals Covered310
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $29,650
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $591,448
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number729662
    Policy instance 1
    Insurance contract or identification number729662
    Number of Individuals Covered505
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $34,479
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $687,548
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $27,034
    Insurance broker organization code?3
    Insurance broker nameBILLY L. CLARK
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3313968
    Policy instance 1
    Insurance contract or identification number3313968
    Number of Individuals Covered418
    Insurance policy start date2009-06-01
    Insurance policy end date2010-05-31
    Total amount of commissions paid to insurance brokerUSD $44,720
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $890,344
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $22,360
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CIGNA HEALTHCARE OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 95136 )
    Policy contract number3313968
    Policy instance 1
    Insurance contract or identification number3313968
    Number of Individuals Covered240
    Insurance policy start date2008-06-01
    Insurance policy end date2009-05-31
    Total amount of commissions paid to insurance brokerUSD $20,476
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $403,514
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $10,238
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3313968
    Policy instance 2
    Insurance contract or identification number3313968
    Number of Individuals Covered439
    Insurance policy start date2008-06-01
    Insurance policy end date2009-05-31
    Total amount of commissions paid to insurance brokerUSD $42,437
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $853,757
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $21,219
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CIGNA HEALTHCARE OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 95136 )
    Policy contract number3313968
    Policy instance 1
    Insurance contract or identification number3313968
    Number of Individuals Covered310
    Insurance policy start date2007-06-01
    Insurance policy end date2008-05-31
    Total amount of commissions paid to insurance brokerUSD $27,224
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $555,448
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $13,612
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3313968
    Policy instance 2
    Insurance contract or identification number3313968
    Number of Individuals Covered492
    Insurance policy start date2007-06-01
    Insurance policy end date2008-05-31
    Total amount of commissions paid to insurance brokerUSD $45,714
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $916,617
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $22,857
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3313968
    Policy instance 2
    Insurance contract or identification number3313968
    Number of Individuals Covered443
    Insurance policy start date2006-06-01
    Insurance policy end date2007-05-31
    Total amount of commissions paid to insurance brokerUSD $46,003
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $914,169
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $23,002
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CIGNA HEALTHCARE OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 95136 )
    Policy contract number3313968
    Policy instance 1
    Insurance contract or identification number3313968
    Number of Individuals Covered382
    Insurance policy start date2006-06-01
    Insurance policy end date2007-05-31
    Total amount of commissions paid to insurance brokerUSD $28,966
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $574,342
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $14,483
    Insurance broker organization code?3
    Insurance broker nameBRYN T. HENRY
    CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
    Policy contract number3313968
    Policy instance 2
    Insurance contract or identification number3313968
    Number of Individuals Covered290
    Insurance policy start date2005-06-01
    Insurance policy end date2006-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    CIGNA HEALTHCARE OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 95136 )
    Policy contract number3313968
    Policy instance 1
    Insurance contract or identification number3313968
    Number of Individuals Covered290
    Insurance policy start date2005-06-01
    Insurance policy end date2006-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    UNITED HEALTHCARE BENEFITS OF TX (National Association of Insurance Commissioners NAIC id number: 95174 )
    Policy contract number0001086-0001
    Policy instance 2
    Insurance contract or identification number0001086-0001
    Number of Individuals Covered290
    Insurance policy start date2005-01-01
    Insurance policy end date2005-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    UNITED HEALTHCARE BENEFITS OF TX (National Association of Insurance Commissioners NAIC id number: 95174 )
    Policy contract number0001086-0001
    Policy instance 1
    Insurance contract or identification number0001086-0001
    Number of Individuals Covered290
    Insurance policy start date2004-01-01
    Insurance policy end date2004-12-31
    Total amount of commissions paid to insurance brokerUSD $16,251
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $325,176
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $16,251
    Insurance broker organization code?3
    Insurance broker nameBBVA COMPASS INSURANCE AGENCY, INC.
    UNITED HEALTHCARE BENEFITS OF TX (National Association of Insurance Commissioners NAIC id number: 95174 )
    Policy contract number0001086-0001
    Policy instance 1
    Insurance contract or identification number0001086-0001
    Number of Individuals Covered291
    Insurance policy start date2003-01-01
    Insurance policy end date2003-12-31
    Total amount of commissions paid to insurance brokerUSD $25,231
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $504,564
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25,231
    Insurance broker organization code?3
    Insurance broker nameBBVA COMPASS INSURANCE AGENCY, INC.
    UNITED HEALTHCARE BENEFITS OF TX (National Association of Insurance Commissioners NAIC id number: 95174 )
    Policy contract number0001086-0001
    Policy instance 1
    Insurance contract or identification number0001086-0001
    Number of Individuals Covered269
    Insurance policy start date2002-01-01
    Insurance policy end date2002-12-31
    Total amount of commissions paid to insurance brokerUSD $11,753
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare 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 $235,054
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,753
    Insurance broker organization code?3
    Insurance broker nameBBVA COMPASS INSURANCE AGENCY, INC.

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