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LEGACY PROFESSIONALS LLP WELFARE 401k Plan overview

Plan NameLEGACY PROFESSIONALS LLP WELFARE
Plan identification number 501

LEGACY PROFESSIONALS LLP WELFARE Benefits

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

401k Sponsoring company profile

LEGACY PROFESSIONALS LLP C/O CRAIG RESCH has sponsored the creation of one or more 401k plans.

Company Name:LEGACY PROFESSIONALS LLP C/O CRAIG RESCH
Employer identification number (EIN):320043599
NAIC Classification:541211
NAIC Description:Offices of Certified Public Accountants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEGACY PROFESSIONALS LLP WELFARE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01BRUCE PAVLIK BRUCE PAVLIK2018-10-02
5012016-01-01BRUCE PAVLIK BRUCE PAVLIK2017-07-10
5012015-01-01BRUCE PAVLIK BRUCE PAVLIK2016-08-10
5012014-01-01BRUCE PAVLIK BRUCE PAVLIK2015-08-31
5012013-01-01BRUCE PAVLIK BRUCE PAVLIK2014-10-06
5012012-01-01BRUCE PAVLIK BRUCE PAVLIK2013-06-17
5012011-01-01BRUCE PAVLIK
5012010-01-01BRUCE PAVLIK
5012009-01-01BRUCE PAVLIK

Plan Statistics for LEGACY PROFESSIONALS LLP WELFARE

401k plan membership statisitcs for LEGACY PROFESSIONALS LLP WELFARE

Measure Date Value
2022: LEGACY PROFESSIONALS LLP WELFARE 2022 401k membership
Total participants, beginning-of-year2022-01-0199
Total number of active participants reported on line 7a of the Form 55002022-01-01114
Total of all active and inactive participants2022-01-01114
2021: LEGACY PROFESSIONALS LLP WELFARE 2021 401k membership
Total participants, beginning-of-year2021-01-01104
Total number of active participants reported on line 7a of the Form 55002021-01-0199
Total of all active and inactive participants2021-01-0199
2020: LEGACY PROFESSIONALS LLP WELFARE 2020 401k membership
Total participants, beginning-of-year2020-01-01105
Total number of active participants reported on line 7a of the Form 55002020-01-01104
Total of all active and inactive participants2020-01-01104
2019: LEGACY PROFESSIONALS LLP WELFARE 2019 401k membership
Total participants, beginning-of-year2019-01-0193
Total number of active participants reported on line 7a of the Form 55002019-01-01105
Total of all active and inactive participants2019-01-01105
2018: LEGACY PROFESSIONALS LLP WELFARE 2018 401k membership
Total participants, beginning-of-year2018-01-0195
Total number of active participants reported on line 7a of the Form 55002018-01-0193
Total of all active and inactive participants2018-01-0193
2017: LEGACY PROFESSIONALS LLP WELFARE 2017 401k membership
Total participants, beginning-of-year2017-01-0195
Total number of active participants reported on line 7a of the Form 55002017-01-0195
Total of all active and inactive participants2017-01-0195
2016: LEGACY PROFESSIONALS LLP WELFARE 2016 401k membership
Total participants, beginning-of-year2016-01-0190
Total number of active participants reported on line 7a of the Form 55002016-01-0195
Total of all active and inactive participants2016-01-0195
2015: LEGACY PROFESSIONALS LLP WELFARE 2015 401k membership
Total participants, beginning-of-year2015-01-0194
Total number of active participants reported on line 7a of the Form 55002015-01-0190
Total of all active and inactive participants2015-01-0190
2014: LEGACY PROFESSIONALS LLP WELFARE 2014 401k membership
Total participants, beginning-of-year2014-01-0196
Total number of active participants reported on line 7a of the Form 55002014-01-0194
Total of all active and inactive participants2014-01-0194
2013: LEGACY PROFESSIONALS LLP WELFARE 2013 401k membership
Total participants, beginning-of-year2013-01-0195
Total number of active participants reported on line 7a of the Form 55002013-01-0196
Total of all active and inactive participants2013-01-0196
2012: LEGACY PROFESSIONALS LLP WELFARE 2012 401k membership
Total participants, beginning-of-year2012-01-0191
Total number of active participants reported on line 7a of the Form 55002012-01-0195
Total of all active and inactive participants2012-01-0195
2011: LEGACY PROFESSIONALS LLP WELFARE 2011 401k membership
Total participants, beginning-of-year2011-01-01101
Total number of active participants reported on line 7a of the Form 55002011-01-0191
Total of all active and inactive participants2011-01-0191
2010: LEGACY PROFESSIONALS LLP WELFARE 2010 401k membership
Total participants, beginning-of-year2010-01-01114
Total number of active participants reported on line 7a of the Form 55002010-01-01101
Total of all active and inactive participants2010-01-01101
2009: LEGACY PROFESSIONALS LLP WELFARE 2009 401k membership
Total participants, beginning-of-year2009-01-01108
Total number of active participants reported on line 7a of the Form 55002009-01-01114
Total of all active and inactive participants2009-01-01114

Form 5500 Responses for LEGACY PROFESSIONALS LLP WELFARE

2022: LEGACY PROFESSIONALS LLP WELFARE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: LEGACY PROFESSIONALS LLP WELFARE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LEGACY PROFESSIONALS LLP WELFARE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LEGACY PROFESSIONALS LLP WELFARE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: LEGACY PROFESSIONALS LLP WELFARE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LEGACY PROFESSIONALS LLP WELFARE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: LEGACY PROFESSIONALS LLP WELFARE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LEGACY PROFESSIONALS LLP WELFARE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LEGACY PROFESSIONALS LLP WELFARE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LEGACY PROFESSIONALS LLP WELFARE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LEGACY PROFESSIONALS LLP WELFARE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LEGACY PROFESSIONALS LLP WELFARE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: LEGACY PROFESSIONALS LLP WELFARE 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: LEGACY PROFESSIONALS LLP WELFARE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 6
Insurance contract or identification number99066643
Number of Individuals Covered22
Insurance policy start date2021-01-16
Insurance policy end date2022-01-15
Total amount of commissions paid to insurance brokerUSD $299
Total amount of fees paid to insurance companyUSD $38
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $299
Amount paid for insurance broker fees38
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 5
Insurance contract or identification number122481
Number of Individuals Covered177
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,294
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $33,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,294
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF012681
Policy instance 4
Insurance contract or identification numberF012681
Number of Individuals Covered187
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $8,787
Total amount of fees paid to insurance companyUSD $5,328
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $42,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,787
Amount paid for insurance broker fees5328
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?1
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number541506 0010
Policy instance 3
Insurance contract or identification number541506 0010
Number of Individuals Covered170
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,121
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,414
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5393922
Policy instance 2
Insurance contract or identification number5393922
Number of Individuals Covered328
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,722
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,815
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 1
Insurance contract or identification numberP15089
Number of Individuals Covered226
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $52,196
Total amount of fees paid to insurance companyUSD $9,837
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,325,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,196
Amount paid for insurance broker fees9837
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 1
Insurance contract or identification number99066643
Number of Individuals Covered21
Insurance policy start date2020-01-16
Insurance policy end date2021-01-15
Total amount of commissions paid to insurance brokerUSD $357
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $357
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF012681
Policy instance 2
Insurance contract or identification numberF012681
Number of Individuals Covered107
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,501
Total amount of fees paid to insurance companyUSD $5,207
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,501
Amount paid for insurance broker fees5207
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number541506 0010
Policy instance 3
Insurance contract or identification number541506 0010
Number of Individuals Covered136
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,235
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,490
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 4
Insurance contract or identification number122481
Number of Individuals Covered140
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,902
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $34,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,902
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 5
Insurance contract or identification numberP15089
Number of Individuals Covered192
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $49,854
Total amount of fees paid to insurance companyUSD $9,732
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,258,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,854
Amount paid for insurance broker fees9732
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number541506 0010
Policy instance 5
Insurance contract or identification number541506 0010
Number of Individuals Covered145
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,274
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,516
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 4
Insurance contract or identification numberP15089
Number of Individuals Covered197
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $45,794
Total amount of fees paid to insurance companyUSD $9,671
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,181,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,794
Amount paid for insurance broker fees9671
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 3
Insurance contract or identification number99066643
Number of Individuals Covered24
Insurance policy start date2019-01-16
Insurance policy end date2020-01-15
Total amount of commissions paid to insurance brokerUSD $357
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $357
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 2
Insurance contract or identification number122481
Number of Individuals Covered151
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,955
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $28,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,955
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF012681
Policy instance 1
Insurance contract or identification numberF012681
Number of Individuals Covered143
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,214
Total amount of fees paid to insurance companyUSD $5,023
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,214
Amount paid for insurance broker fees5023
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 1
Insurance contract or identification number122481
Number of Individuals Covered151
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,362
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $31,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,362
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF012681
Policy instance 2
Insurance contract or identification numberF012681
Number of Individuals Covered145
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,164
Total amount of fees paid to insurance companyUSD $4,582
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,164
Amount paid for insurance broker fees4582
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 3
Insurance contract or identification number99066643
Number of Individuals Covered24
Insurance policy start date2018-01-16
Insurance policy end date2019-01-15
Total amount of commissions paid to insurance brokerUSD $408
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $408
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 4
Insurance contract or identification numberP15089
Number of Individuals Covered194
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $47,394
Total amount of fees paid to insurance companyUSD $9,188
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,194,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,394
Amount paid for insurance broker fees9188
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF012681
Policy instance 1
Insurance contract or identification numberF012681
Number of Individuals Covered141
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,677
Total amount of fees paid to insurance companyUSD $4,126
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $42,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,677
Amount paid for insurance broker fees4126
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 2
Insurance contract or identification number99066643
Number of Individuals Covered21
Insurance policy start date2017-01-16
Insurance policy end date2018-01-16
Total amount of commissions paid to insurance brokerUSD $313
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $313
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 3
Insurance contract or identification numberP15089
Number of Individuals Covered204
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $42,176
Total amount of fees paid to insurance companyUSD $2,727
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,083,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,176
Amount paid for insurance broker fees2727
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 4
Insurance contract or identification number122481
Number of Individuals Covered141
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,554
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $18,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,554
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99066643
Policy instance 4
Insurance contract or identification number99066643
Number of Individuals Covered21
Insurance policy start date2016-01-17
Insurance policy end date2017-01-16
Total amount of commissions paid to insurance brokerUSD $313
Total amount of fees paid to insurance companyUSD $16
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $313
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerGUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTHE DANIEL AND HENRY COMPANY
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberP15089
Policy instance 3
Insurance contract or identification numberP15089
Number of Individuals Covered201
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $43,530
Total amount of fees paid to insurance companyUSD $540
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,091,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,530
Amount paid for insurance broker fees540
Additional information about fees paid to insurance brokerEMPLOYEE BENEFIT RISK MGMT
Insurance broker organization code?3
Insurance broker nameELITE ADMINISTRATION & INSURANCE
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFO12681
Policy instance 2
Insurance contract or identification numberFO12681
Number of Individuals Covered129
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,155
Total amount of fees paid to insurance companyUSD $4,069
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,155
Amount paid for insurance broker fees4069
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameELITE ADMINSTRATION & INC GRP INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number122481
Policy instance 1
Insurance contract or identification number122481
Number of Individuals Covered112
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,940
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Other welfare benefits providedLONG TERM CARE
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 $34,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,940
Insurance broker organization code?3
Insurance broker nameELITE ADMINISTRATION & INSURANCE

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