OVERFLOW ENERGY LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2023 401k financial data |
|---|
| Total income from all sources (including contributions) | 2023-04-30 | $2,452,382 |
| Total of all expenses incurred | 2023-04-30 | $2,452,382 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-04-30 | $2,223,422 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-04-30 | $2,452,382 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-04-30 | $228,960 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-04-30 | No |
| Was this plan covered by a fidelity bond | 2023-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-04-30 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2023-04-30 | $243,971 |
| Administrative expenses (other) incurred | 2023-04-30 | $117,958 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-04-30 | No |
| Value of net income/loss | 2023-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-04-30 | $547,899 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-04-30 | No |
| Contributions received in cash from employer | 2023-04-30 | $2,208,411 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-04-30 | $1,675,523 |
| Contract administrator fees | 2023-04-30 | $111,002 |
| Did the plan have assets held for investment | 2023-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-04-30 | Yes |
| 2022 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-04-30 | $2,373,665 |
| Total of all expenses incurred | 2022-04-30 | $2,373,665 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-04-30 | $2,167,782 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-04-30 | $2,373,665 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-04-30 | $205,883 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-04-30 | No |
| Was this plan covered by a fidelity bond | 2022-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-04-30 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-04-30 | $373,849 |
| Administrative expenses (other) incurred | 2022-04-30 | $90,630 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-04-30 | No |
| Value of net income/loss | 2022-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-04-30 | $518,876 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-04-30 | No |
| Contributions received in cash from employer | 2022-04-30 | $1,999,816 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-04-30 | $1,648,906 |
| Contract administrator fees | 2022-04-30 | $115,253 |
| Did the plan have assets held for investment | 2022-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-04-30 | Yes |
| 2020 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-04-30 | $2,598,529 |
| Total of all expenses incurred | 2020-04-30 | $2,598,529 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-04-30 | $2,376,546 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-04-30 | $2,598,529 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-04-30 | $221,983 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-04-30 | No |
| Was this plan covered by a fidelity bond | 2020-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-04-30 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-04-30 | $194,396 |
| Administrative expenses (other) incurred | 2020-04-30 | $104,259 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
| Value of net income/loss | 2020-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-04-30 | $393,832 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-04-30 | No |
| Contributions received in cash from employer | 2020-04-30 | $2,404,133 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-04-30 | $1,982,714 |
| Contract administrator fees | 2020-04-30 | $117,724 |
| Did the plan have assets held for investment | 2020-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-04-30 | Yes |
| 2019 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-04-30 | $2,056,676 |
| Total of all expenses incurred | 2019-04-30 | $2,056,676 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-04-30 | $1,860,116 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-04-30 | $2,056,676 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-04-30 | $196,560 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-04-30 | No |
| Was this plan covered by a fidelity bond | 2019-04-30 | No |
| Contributions received from participants | 2019-04-30 | $561,044 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-04-30 | $79,641 |
| Administrative expenses (other) incurred | 2019-04-30 | $90,203 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
| Value of net income/loss | 2019-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-04-30 | $343,192 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-04-30 | No |
| Contributions received in cash from employer | 2019-04-30 | $1,415,991 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-04-30 | $1,516,924 |
| Contract administrator fees | 2019-04-30 | $106,357 |
| Did the plan have assets held for investment | 2019-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-04-30 | Yes |
| 2018 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-04-30 | $1,322,911 |
| Total of all expenses incurred | 2018-04-30 | $1,322,911 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-04-30 | $1,213,915 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-04-30 | $1,322,911 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-04-30 | $108,996 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-04-30 | No |
| Was this plan covered by a fidelity bond | 2018-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-04-30 | No |
| Contributions received from participants | 2018-04-30 | $561,044 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-04-30 | $137,856 |
| Administrative expenses (other) incurred | 2018-04-30 | $59,406 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
| Value of net income/loss | 2018-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-04-30 | $212,097 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-04-30 | No |
| Contributions received in cash from employer | 2018-04-30 | $624,011 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-04-30 | $1,001,818 |
| Contract administrator fees | 2018-04-30 | $49,590 |
| Did the plan have assets held for investment | 2018-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-04-30 | Yes |
| 2017 : OVERFLOW ENERGY LLC HEALTH BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-04-30 | $1,392,246 |
| Total of all expenses incurred | 2017-04-30 | $1,392,246 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-04-30 | $1,303,217 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-04-30 | $1,392,246 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-04-30 | $89,029 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-04-30 | No |
| Was this plan covered by a fidelity bond | 2017-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-04-30 | No |
| Contributions received from participants | 2017-04-30 | $480,254 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-04-30 | $423,639 |
| Administrative expenses (other) incurred | 2017-04-30 | $34,344 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-04-30 | No |
| Value of net income/loss | 2017-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-04-30 | $191,514 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-04-30 | No |
| Contributions received in cash from employer | 2017-04-30 | $488,353 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-04-30 | $1,111,703 |
| Contract administrator fees | 2017-04-30 | $54,685 |
| Did the plan have assets held for investment | 2017-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-04-30 | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | S261361 |
| Policy instance | 3 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $2,256 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,128 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S261361 |
| Policy instance | 2 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $18,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | S261361 |
| Policy instance | 1 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of fees paid to insurance company | USD $87,064 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $507,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 69651 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | S261361 |
| Policy instance | 3 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $1,809 | | Total amount of fees paid to insurance company | USD $1,809 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $18,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,809 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1809 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S261361 |
| Policy instance | 2 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $16,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | S261361 |
| Policy instance | 1 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of fees paid to insurance company | USD $79,776 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $483,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 63819 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | S261361 |
| Policy instance | 3 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $3,566 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $19,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,783 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S261361 |
| Policy instance | 2 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $20,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 ) |
| Policy contract number | S261361 |
| Policy instance | 1 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of fees paid to insurance company | USD $81,191 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $353,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 64953 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | S261361 |
| Policy instance | 3 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $3,490 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $17,489 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,745 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S261361 |
| Policy instance | 2 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $19,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 ) |
| Policy contract number | S261361 |
| Policy instance | 1 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of fees paid to insurance company | USD $75,256 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $306,480 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 61710 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | S261361 |
| Policy instance | 3 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $2,208 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,104 | | Insurance broker organization code? | 3 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S261361 |
| Policy instance | 2 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Other welfare benefits provided | TRANSPLANT POLICY | | Welfare Benefit Premiums Paid to Carrier | USD $12,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL INSURANCE COMPANY OF TEXAS (National Association of Insurance Commissioners NAIC id number: 71773 ) |
| Policy contract number | S261361 |
| Policy instance | 1 |
| Insurance contract or identification number | S261361 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of fees paid to insurance company | USD $52,829 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $188,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 43320 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | INSURANCE MANAGEMENT SERVICES |
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