VEE PAK, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VEE PAK, INC. HEALTH, LIFE & AD&D PLAN
401k plan membership statisitcs for VEE PAK, INC. HEALTH, LIFE & AD&D PLAN
| Measure | Date | Value |
|---|
| 2015: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 260 |
| Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
| Total of all active and inactive participants | 2015-12-01 | 260 |
| 2014: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 237 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 252 |
| Number of retired or separated participants receiving benefits | 2014-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
| Total of all active and inactive participants | 2014-12-01 | 252 |
| 2013: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 237 |
| Number of retired or separated participants receiving benefits | 2013-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
| Total of all active and inactive participants | 2013-12-01 | 237 |
| 2012: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 209 |
| Total of all active and inactive participants | 2012-12-01 | 209 |
| 2011: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 200 |
| Total of all active and inactive participants | 2011-12-01 | 200 |
| 2010: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-12-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 150 |
| Number of retired or separated participants receiving benefits | 2010-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-12-01 | 0 |
| Total of all active and inactive participants | 2010-12-01 | 150 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-12-01 | 0 |
| Total participants | 2010-12-01 | 150 |
| 2009: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 145 |
| Number of retired or separated participants receiving benefits | 2009-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-12-01 | 0 |
| Total of all active and inactive participants | 2009-12-01 | 145 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-12-01 | 0 |
| Total participants | 2009-12-01 | 145 |
| 2008: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-12-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-12-01 | 140 |
| Number of retired or separated participants receiving benefits | 2008-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-12-01 | 0 |
| Total of all active and inactive participants | 2008-12-01 | 140 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-12-01 | 0 |
| Total participants | 2008-12-01 | 140 |
| 2007: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-12-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-12-01 | 148 |
| Number of retired or separated participants receiving benefits | 2007-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-12-01 | 0 |
| Total of all active and inactive participants | 2007-12-01 | 148 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2007-12-01 | 0 |
| Total participants | 2007-12-01 | 148 |
| 2006: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-12-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-12-01 | 119 |
| Number of retired or separated participants receiving benefits | 2006-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-12-01 | 0 |
| Total of all active and inactive participants | 2006-12-01 | 119 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2006-12-01 | 0 |
| Total participants | 2006-12-01 | 119 |
| 2005: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-12-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-12-01 | 121 |
| Number of retired or separated participants receiving benefits | 2005-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-12-01 | 0 |
| Total of all active and inactive participants | 2005-12-01 | 121 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2005-12-01 | 0 |
| Total participants | 2005-12-01 | 121 |
| 2004: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-12-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-12-01 | 86 |
| Number of retired or separated participants receiving benefits | 2004-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-12-01 | 0 |
| Total of all active and inactive participants | 2004-12-01 | 86 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2004-12-01 | 0 |
| Total participants | 2004-12-01 | 86 |
| 2003: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-12-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-12-01 | 122 |
| Number of retired or separated participants receiving benefits | 2003-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-12-01 | 0 |
| Total of all active and inactive participants | 2003-12-01 | 122 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2003-12-01 | 0 |
| Total participants | 2003-12-01 | 122 |
| 2002: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-12-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-12-01 | 121 |
| Number of retired or separated participants receiving benefits | 2002-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-12-01 | 0 |
| Total of all active and inactive participants | 2002-12-01 | 121 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2002-12-01 | 0 |
| Total participants | 2002-12-01 | 121 |
| 2015: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2010 form 5500 responses |
|---|
| 2010-12-01 | Type of plan entity | Single employer plan |
| 2010-12-01 | Submission has been amended | No |
| 2010-12-01 | This submission is the final filing | No |
| 2010-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-12-01 | Plan is a collectively bargained plan | No |
| 2010-12-01 | Plan funding arrangement – Insurance | Yes |
| 2010-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2009 form 5500 responses |
|---|
| 2009-12-01 | Type of plan entity | Single employer plan |
| 2009-12-01 | Submission has been amended | No |
| 2009-12-01 | This submission is the final filing | No |
| 2009-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-12-01 | Plan is a collectively bargained plan | No |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2008 form 5500 responses |
|---|
| 2008-12-01 | Type of plan entity | Single employer plan |
| 2008-12-01 | Submission has been amended | No |
| 2008-12-01 | This submission is the final filing | No |
| 2008-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-12-01 | Plan is a collectively bargained plan | No |
| 2008-12-01 | Plan funding arrangement – Insurance | Yes |
| 2008-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2007 form 5500 responses |
|---|
| 2007-12-01 | Type of plan entity | Single employer plan |
| 2007-12-01 | Submission has been amended | No |
| 2007-12-01 | This submission is the final filing | No |
| 2007-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-12-01 | Plan is a collectively bargained plan | No |
| 2007-12-01 | Plan funding arrangement – Insurance | Yes |
| 2007-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2006 form 5500 responses |
|---|
| 2006-12-01 | Type of plan entity | Single employer plan |
| 2006-12-01 | Submission has been amended | No |
| 2006-12-01 | This submission is the final filing | No |
| 2006-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-12-01 | Plan is a collectively bargained plan | No |
| 2006-12-01 | Plan funding arrangement – Insurance | Yes |
| 2006-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2005 form 5500 responses |
|---|
| 2005-12-01 | Type of plan entity | Single employer plan |
| 2005-12-01 | Submission has been amended | No |
| 2005-12-01 | This submission is the final filing | No |
| 2005-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-12-01 | Plan is a collectively bargained plan | No |
| 2005-12-01 | Plan funding arrangement – Insurance | Yes |
| 2005-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2004 form 5500 responses |
|---|
| 2004-12-01 | Type of plan entity | Single employer plan |
| 2004-12-01 | Submission has been amended | No |
| 2004-12-01 | This submission is the final filing | No |
| 2004-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-12-01 | Plan is a collectively bargained plan | No |
| 2004-12-01 | Plan funding arrangement – Insurance | Yes |
| 2004-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2003 form 5500 responses |
|---|
| 2003-12-01 | Type of plan entity | Single employer plan |
| 2003-12-01 | Submission has been amended | No |
| 2003-12-01 | This submission is the final filing | No |
| 2003-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-12-01 | Plan is a collectively bargained plan | No |
| 2003-12-01 | Plan funding arrangement – Insurance | Yes |
| 2003-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: VEE PAK, INC. HEALTH, LIFE & AD&D PLAN 2002 form 5500 responses |
|---|
| 2002-12-01 | Type of plan entity | Single employer plan |
| 2002-12-01 | First time form 5500 has been submitted | Yes |
| 2002-12-01 | Submission has been amended | No |
| 2002-12-01 | This submission is the final filing | No |
| 2002-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-12-01 | Plan is a collectively bargained plan | No |
| 2002-12-01 | Plan funding arrangement – Insurance | Yes |
| 2002-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315 |
| Policy instance | 1 |
| Insurance contract or identification number | B82315 | | Number of Individuals Covered | 518 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $81,369 | | Total amount of fees paid to insurance company | USD $1,485 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,354,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,369 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1485 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 245 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $711 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $711 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & CO INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 513 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $69,028 | | Total amount of fees paid to insurance company | USD $1,428 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,999,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,028 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1428 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $1,546 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $21,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,546 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & CO INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $1,439 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $19,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,439 | | Insurance broker name | MCNELLIS & CO INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 496 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $48,572 | | Total amount of fees paid to insurance company | USD $1,090 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,620,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,572 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1090 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 500 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $54,005 | | Total amount of fees paid to insurance company | USD $995 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,350,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $1,268 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $15,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $13,252 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 404 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $52,737 | | Total amount of fees paid to insurance company | USD $1,111 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $1,343,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,737 | | Amount paid for insurance broker fees | 1111 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $1,095 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $13,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,095 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 415 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $50,991 | | Total amount of fees paid to insurance company | USD $647 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $1,285,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,991 | | Amount paid for insurance broker fees | 647 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2008-12-01 | | Insurance policy end date | 2009-11-30 | | Total amount of commissions paid to insurance broker | USD $1,061 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $12,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,061 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 416 | | Insurance policy start date | 2008-12-01 | | Insurance policy end date | 2009-11-30 | | Total amount of commissions paid to insurance broker | USD $50,247 | | Total amount of fees paid to insurance company | USD $1,082 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $1,192,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,247 | | Amount paid for insurance broker fees | 1082 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 1 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2007-12-01 | | Insurance policy end date | 2008-11-30 | | Total amount of commissions paid to insurance broker | USD $1,066 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $13,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,066 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 2 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 383 | | Insurance policy start date | 2007-12-01 | | Insurance policy end date | 2008-11-30 | | Total amount of commissions paid to insurance broker | USD $35,358 | | Total amount of fees paid to insurance company | USD $1,036 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $1,071,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,358 | | Amount paid for insurance broker fees | 1036 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2006-12-01 | | Insurance policy end date | 2007-11-30 | | Total amount of commissions paid to insurance broker | USD $1,038 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $12,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,038 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 307 | | Insurance policy start date | 2006-12-01 | | Insurance policy end date | 2007-11-30 | | Total amount of commissions paid to insurance broker | USD $34,900 | | Total amount of fees paid to insurance company | USD $1,100 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $973,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,900 | | Amount paid for insurance broker fees | 1100 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2005-12-01 | | Insurance policy end date | 2006-11-30 | | Total amount of commissions paid to insurance broker | USD $1,017 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $11,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,017 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 310 | | Insurance policy start date | 2005-12-01 | | Insurance policy end date | 2006-11-30 | | Total amount of commissions paid to insurance broker | USD $34,458 | | Total amount of fees paid to insurance company | USD $1,042 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $885,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,458 | | Amount paid for insurance broker fees | 1042 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 225 | | Insurance policy start date | 2004-12-01 | | Insurance policy end date | 2005-11-30 | | Total amount of commissions paid to insurance broker | USD $34,123 | | Total amount of fees paid to insurance company | USD $877 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $810,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,123 | | Amount paid for insurance broker fees | 877 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2004-12-01 | | Insurance policy end date | 2005-11-30 | | Total amount of commissions paid to insurance broker | USD $984 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $11,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $984 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 2 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 305 | | Insurance policy start date | 2003-12-01 | | Insurance policy end date | 2004-11-30 | | Total amount of commissions paid to insurance broker | USD $33,125 | | Total amount of fees paid to insurance company | USD $875 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $850,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,125 | | Amount paid for insurance broker fees | 875 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 1 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2003-12-01 | | Insurance policy end date | 2004-11-30 | | Total amount of commissions paid to insurance broker | USD $950 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $10,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $950 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F182315 |
| Policy instance | 2 |
| Insurance contract or identification number | F182315 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2002-12-01 | | Insurance policy end date | 2003-11-30 | | Total amount of commissions paid to insurance broker | USD $900 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $10,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $900 | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | B82315B |
| Policy instance | 1 |
| Insurance contract or identification number | B82315B | | Number of Individuals Covered | 305 | | Insurance policy start date | 2002-12-01 | | Insurance policy end date | 2003-11-30 | | Total amount of commissions paid to insurance broker | USD $32,150 | | Total amount of fees paid to insurance company | USD $850 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $840,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,150 | | Amount paid for insurance broker fees | 850 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | MCNELLIS & COMPANY |
|
