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EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 401k Plan overview

Plan NameEASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN
Plan identification number 501

EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN Benefits

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

401k Sponsoring company profile

EASTER SEALS METROPOLITAN CHICAGO, INC. has sponsored the creation of one or more 401k plans.

Company Name:EASTER SEALS METROPOLITAN CHICAGO, INC.
Employer identification number (EIN):362169153
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-07-01AMY CURTIS
5012015-05-01AMY CURTIS AMY CURTIS2016-02-19
5012014-05-01AMY CURTIS AMY CURTIS2015-11-13
5012013-05-01AMY CURTIS
5012012-05-01AMY CURTIS
5012011-05-01AMY CURTIS AMY CURTIS2012-10-26
5012010-05-01AMY CURTIS AMY CURTIS2011-10-10
5012009-05-01SUZANNE BRALEY
5012008-05-01SUZANNE BRALEY
5012007-05-01SUZANNE BRALEY
5012006-05-01SUZANNE BRALEY
5012005-05-01SUZANNE BRALEY
5012004-05-01SUZANNE BRALEY
5012003-05-01SUZANNE BRALEY
5012002-05-01SUZANNE BRALEY

Plan Statistics for EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN

401k plan membership statisitcs for EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN

Measure Date Value
2015: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01321
Total number of active participants reported on line 7a of the Form 55002015-07-010
Number of retired or separated participants receiving benefits2015-07-010
Total of all active and inactive participants2015-07-010
Total participants, beginning-of-year2015-05-01325
Total number of active participants reported on line 7a of the Form 55002015-05-01318
Number of retired or separated participants receiving benefits2015-05-013
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01321
2014: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01300
Total number of active participants reported on line 7a of the Form 55002014-05-01306
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01306
2013: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01433
Total number of active participants reported on line 7a of the Form 55002013-05-01393
Number of retired or separated participants receiving benefits2013-05-012
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01395
2012: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01347
Total number of active participants reported on line 7a of the Form 55002012-05-01328
Number of retired or separated participants receiving benefits2012-05-012
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01330
2011: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01340
Total number of active participants reported on line 7a of the Form 55002011-05-01349
Number of retired or separated participants receiving benefits2011-05-013
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01352
2010: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-01361
Total number of active participants reported on line 7a of the Form 55002010-05-01375
Number of retired or separated participants receiving benefits2010-05-017
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-01382
2009: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01273
Total number of active participants reported on line 7a of the Form 55002009-05-01361
Number of retired or separated participants receiving benefits2009-05-016
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-01367
2008: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2008 401k membership
Total participants, beginning-of-year2008-05-01256
Total number of active participants reported on line 7a of the Form 55002008-05-01273
Number of retired or separated participants receiving benefits2008-05-015
Number of other retired or separated participants entitled to future benefits2008-05-010
Total of all active and inactive participants2008-05-01278
2007: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2007 401k membership
Total participants, beginning-of-year2007-05-01233
Total number of active participants reported on line 7a of the Form 55002007-05-01256
Number of retired or separated participants receiving benefits2007-05-015
Number of other retired or separated participants entitled to future benefits2007-05-010
Total of all active and inactive participants2007-05-01261
2006: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2006 401k membership
Total participants, beginning-of-year2006-05-01208
Total number of active participants reported on line 7a of the Form 55002006-05-01233
Number of retired or separated participants receiving benefits2006-05-012
Number of other retired or separated participants entitled to future benefits2006-05-010
Total of all active and inactive participants2006-05-01235
2005: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2005 401k membership
Total participants, beginning-of-year2005-05-01187
Total number of active participants reported on line 7a of the Form 55002005-05-01208
Number of retired or separated participants receiving benefits2005-05-010
Number of other retired or separated participants entitled to future benefits2005-05-010
Total of all active and inactive participants2005-05-01208
2004: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2004 401k membership
Total participants, beginning-of-year2004-05-01125
Total number of active participants reported on line 7a of the Form 55002004-05-01187
Number of retired or separated participants receiving benefits2004-05-011
Number of other retired or separated participants entitled to future benefits2004-05-010
Total of all active and inactive participants2004-05-01188
2003: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2003 401k membership
Total participants, beginning-of-year2003-05-01121
Total number of active participants reported on line 7a of the Form 55002003-05-01125
Number of retired or separated participants receiving benefits2003-05-010
Number of other retired or separated participants entitled to future benefits2003-05-010
Total of all active and inactive participants2003-05-01125
2002: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2002 401k membership
Total participants, beginning-of-year2002-05-01124
Total number of active participants reported on line 7a of the Form 55002002-05-01121
Number of retired or separated participants receiving benefits2002-05-010
Number of other retired or separated participants entitled to future benefits2002-05-010
Total of all active and inactive participants2002-05-01121

Form 5500 Responses for EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN

2015: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingYes
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Submission has been amendedYes
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes
2008: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2008 form 5500 responses
2008-05-01Type of plan entitySingle employer plan
2008-05-01Submission has been amendedNo
2008-05-01This submission is the final filingNo
2008-05-01This return/report is a short plan year return/report (less than 12 months)No
2008-05-01Plan is a collectively bargained planNo
2008-05-01Plan funding arrangement – InsuranceYes
2008-05-01Plan benefit arrangement – InsuranceYes
2007: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2007 form 5500 responses
2007-05-01Type of plan entitySingle employer plan
2007-05-01Submission has been amendedNo
2007-05-01This submission is the final filingNo
2007-05-01This return/report is a short plan year return/report (less than 12 months)No
2007-05-01Plan is a collectively bargained planNo
2007-05-01Plan funding arrangement – InsuranceYes
2007-05-01Plan benefit arrangement – InsuranceYes
2006: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2006 form 5500 responses
2006-05-01Type of plan entitySingle employer plan
2006-05-01Submission has been amendedNo
2006-05-01This submission is the final filingNo
2006-05-01This return/report is a short plan year return/report (less than 12 months)No
2006-05-01Plan is a collectively bargained planNo
2006-05-01Plan funding arrangement – InsuranceYes
2006-05-01Plan benefit arrangement – InsuranceYes
2005: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2005 form 5500 responses
2005-05-01Type of plan entitySingle employer plan
2005-05-01Submission has been amendedNo
2005-05-01This submission is the final filingNo
2005-05-01This return/report is a short plan year return/report (less than 12 months)No
2005-05-01Plan is a collectively bargained planNo
2005-05-01Plan funding arrangement – InsuranceYes
2005-05-01Plan benefit arrangement – InsuranceYes
2004: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2004 form 5500 responses
2004-05-01Type of plan entitySingle employer plan
2004-05-01Submission has been amendedNo
2004-05-01This submission is the final filingNo
2004-05-01This return/report is a short plan year return/report (less than 12 months)No
2004-05-01Plan is a collectively bargained planNo
2004-05-01Plan funding arrangement – InsuranceYes
2004-05-01Plan benefit arrangement – InsuranceYes
2003: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2003 form 5500 responses
2003-05-01Type of plan entitySingle employer plan
2003-05-01Submission has been amendedNo
2003-05-01This submission is the final filingNo
2003-05-01This return/report is a short plan year return/report (less than 12 months)No
2003-05-01Plan is a collectively bargained planNo
2003-05-01Plan funding arrangement – InsuranceYes
2003-05-01Plan benefit arrangement – InsuranceYes
2002: EASTER SEALS METROPOLITAN CHICAGO MEDICAL PLAN 2002 form 5500 responses
2002-05-01Type of plan entityMulti-employer plan
2002-05-01First time form 5500 has been submittedYes
2002-05-01Submission has been amendedNo
2002-05-01This submission is the final filingNo
2002-05-01This return/report is a short plan year return/report (less than 12 months)No
2002-05-01Plan is a collectively bargained planNo
2002-05-01Plan funding arrangement – InsuranceYes
2002-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB H P 17255
Policy instance 1
Insurance contract or identification numberB H P 17255
Number of Individuals Covered428
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $86,119
Total amount of fees paid to insurance companyUSD $2,727
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 $2,556,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,119
Amount paid for insurance broker fees2727
Additional information about fees paid to insurance brokerBROKER'S BONUS
Insurance broker organization code?3
Insurance broker nameVISTANATIONAL INSURANCE GROUP INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB H P 17255
Policy instance 1
Insurance contract or identification numberB H P 17255
Number of Individuals Covered420
Insurance policy start date2015-05-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $14,539
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 $415,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,539
Insurance broker organization code?3
Insurance broker nameVISTANATIONAL INSURANCE GROUP INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB H P 17255
Policy instance 1
Insurance contract or identification numberB H P 17255
Number of Individuals Covered407
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $79,756
Total amount of fees paid to insurance companyUSD $2,835
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 $2,372,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,756
Amount paid for insurance broker fees2835
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameVISTANATIONAL INSURANCE GROUP INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB H P 17255
Policy instance 1
Insurance contract or identification numberB H P 17255
Number of Individuals Covered381
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $81,660
Total amount of fees paid to insurance companyUSD $4,579
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 $2,334,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,660
Amount paid for insurance broker fees4579
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameVISTANATIONAL INSURANCE GROUP INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB H P 17255
Policy instance 1
Insurance contract or identification numberB H P 17255
Number of Individuals Covered413
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $89,968
Total amount of fees paid to insurance companyUSD $4,512
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 $2,569,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,968
Amount paid for insurance broker fees4512
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameVISTANATIONAL INSURANCE GROUP INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB P H 17255
Policy instance 1
Insurance contract or identification numberB P H 17255
Number of Individuals Covered452
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $89,229
Total amount of fees paid to insurance companyUSD $4,049
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 $2,545,373
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 numberB P H 17255
Policy instance 1
Insurance contract or identification numberB P H 17255
Number of Individuals Covered366
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $97,525
Total amount of fees paid to insurance companyUSD $5,327
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 $2,429,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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