UFTRING CHEVROLET, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UFTRING AUTO GROUP SECTION 125 PLAN
| Measure | Date | Value |
|---|
| 2022: UFTRING AUTO GROUP SECTION 125 PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 285 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 294 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 294 |
| 2021: UFTRING AUTO GROUP SECTION 125 PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 300 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 285 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 285 |
| 2020: UFTRING AUTO GROUP SECTION 125 PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 300 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 300 |
| 2019: UFTRING AUTO GROUP SECTION 125 PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 325 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 325 |
| 2018: UFTRING AUTO GROUP SECTION 125 PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 325 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 325 |
| 2017: UFTRING AUTO GROUP SECTION 125 PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 333 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 310 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 310 |
| 2016: UFTRING AUTO GROUP SECTION 125 PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 355 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 333 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 333 |
| 2015: UFTRING AUTO GROUP SECTION 125 PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 315 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 355 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 355 |
| 2014: UFTRING AUTO GROUP SECTION 125 PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 292 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 315 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 315 |
| 2013: UFTRING AUTO GROUP SECTION 125 PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 324 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 292 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 292 |
| 2012: UFTRING AUTO GROUP SECTION 125 PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 324 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 324 |
| 2011: UFTRING AUTO GROUP SECTION 125 PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 303 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 312 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 312 |
| 2009: UFTRING AUTO GROUP SECTION 125 PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 282 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 282 |
| 2022: UFTRING AUTO GROUP SECTION 125 PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: UFTRING AUTO GROUP SECTION 125 PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: UFTRING AUTO GROUP SECTION 125 PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: UFTRING AUTO GROUP SECTION 125 PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: UFTRING AUTO GROUP SECTION 125 PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: UFTRING AUTO GROUP SECTION 125 PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: UFTRING AUTO GROUP SECTION 125 PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: UFTRING AUTO GROUP SECTION 125 PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: UFTRING AUTO GROUP SECTION 125 PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: UFTRING AUTO GROUP SECTION 125 PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: UFTRING AUTO GROUP SECTION 125 PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: UFTRING AUTO GROUP SECTION 125 PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: UFTRING AUTO GROUP SECTION 125 PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | First time form 5500 has been submitted | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 77718 |
| Policy instance | 7 |
| Insurance contract or identification number | 77718 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $1,705 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $16,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $905 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 409 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $61,407 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $640,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,407 | | Insurance broker organization code? | 3 |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2021-03-02 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,147 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,147 | | Insurance broker organization code? | 3 |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $12,145 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $12,145 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $323 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $3,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $162 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | C9283 |
| Policy instance | 5 |
| Insurance contract or identification number | C9283 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $608 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $5,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $339 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | EE625 |
| Policy instance | 6 |
| Insurance contract or identification number | EE625 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $191 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $112 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 451 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $66,747 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $647,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,747 | | Insurance broker organization code? | 3 |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2020-03-02 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $2,301 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,301 | | Insurance broker organization code? | 3 |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of fees paid to insurance company | USD $13,254 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 13254 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $437 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $4,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $259 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | EE625 |
| Policy instance | 6 |
| Insurance contract or identification number | EE625 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $190 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $1,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 77718 |
| Policy instance | 7 |
| Insurance contract or identification number | 77718 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $2,003 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $18,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,096 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | C9283 |
| Policy instance | 5 |
| Insurance contract or identification number | C9283 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $708 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $6,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $410 | | Insurance broker organization code? | 3 |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 318 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $2,442 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,442 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 479 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $70,724 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $532,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,724 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 77718 |
| Policy instance | 7 |
| Insurance contract or identification number | 77718 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $2,207 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $20,653 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,231 | | Insurance broker organization code? | 3 |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of fees paid to insurance company | USD $13,820 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 13820 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $419 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $4,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $260 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | C9283 |
| Policy instance | 5 |
| Insurance contract or identification number | C9283 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $759 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $6,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $443 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | EE625 |
| Policy instance | 6 |
| Insurance contract or identification number | EE625 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $191 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $112 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $86,692 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $424,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,564 | | Insurance broker organization code? | 3 |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $2,365 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,365 | | Insurance broker organization code? | 3 |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of fees paid to insurance company | USD $13,584 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 13584 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $469 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $4,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $290 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | EE625 |
| Policy instance | 6 |
| Insurance contract or identification number | EE625 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $191 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $112 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | C9283 |
| Policy instance | 5 |
| Insurance contract or identification number | C9283 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $1,120 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $9,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $632 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 77718 |
| Policy instance | 7 |
| Insurance contract or identification number | 77718 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $2,358 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $22,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,307 | | Insurance broker organization code? | 3 |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 3 |
| Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of fees paid to insurance company | USD $13,456 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 13456 | | Insurance broker organization code? | 3 |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $2,419 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,419 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 480 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $70,948 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $397,423 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,948 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 206788 |
| Policy instance | 1 |
| Insurance contract or identification number | 206788 | | Number of Individuals Covered | 497 | | Insurance policy start date | 2016-03-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $76,450 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $317,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,450 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE SERVICES INC |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,435 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,435 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768, C9283 |
| Policy instance | 3 |
| Insurance contract or identification number | 83768, C9283 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2016-03-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $4,361 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $38,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,498 | | Insurance broker organization code? | 3 | | Insurance broker name | GEORGE OWENS |
|
| GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 4 |
| Insurance policy start date | 2016-04-01 | | Insurance policy end date | 2017-03-31 | | Total amount of fees paid to insurance company | USD $14,315 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 14315 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY HARDESTY |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | C9283, EE625 |
| Policy instance | 5 |
| Insurance contract or identification number | C9283, EE625 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,389 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $12,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $471 | | Insurance broker organization code? | 3 | | Insurance broker name | KYLE HORN |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400, P75786 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400, P75786 | | Number of Individuals Covered | 449 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $61,834 | | Total amount of fees paid to insurance company | USD $45 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $282,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,834 | | Amount paid for insurance broker fees | 23 | | Additional information about fees paid to insurance broker | MISC GIFTS, MEALS, MEETINGS | | Insurance broker organization code? | 3 | | Insurance broker name | UFTRING DEALERSHIPS |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $971 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $971 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,019 | | Total amount of fees paid to insurance company | USD $19,345 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,019 | | Amount paid for insurance broker fees | 19345 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768, C9283 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768, C9283 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $5,205 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $45,614 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $5 | | Insurance broker organization code? | 3 | | Insurance broker name | WAYNE ROWE |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,249 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,249 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,952 | | Total amount of fees paid to insurance company | USD $18,994 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,952 | | Amount paid for insurance broker fees | 18994 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768, C9283 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768, C9283 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-02-28 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | WAYNE ROWE |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400, P79705 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400, P79705 | | Number of Individuals Covered | 474 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $55,526 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,526 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400, P79705 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400, P79705 | | Number of Individuals Covered | 453 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $71,893 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $244,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,893 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,202 | | Total amount of fees paid to insurance company | USD $18,345 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,202 | | Amount paid for insurance broker fees | 18345 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768, C9283 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768, C9283 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,817 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $57,396 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8 | | Insurance broker organization code? | 3 | | Insurance broker name | WAYNE ROWE |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,300 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,300 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 4 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 89 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,969 | | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | | Welfare Benefit Premiums Paid to Carrier | USD $55,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,108 | | Insurance broker organization code? | 3 | | Insurance broker name | JENNIFER WOODRUM |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,779 | | Total amount of fees paid to insurance company | USD $18,782 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,779 | | Amount paid for insurance broker fees | 18782 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,294 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,294 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400, P79705 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400, P79705 | | Number of Individuals Covered | 465 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $87,256 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $206,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,256 | | Insurance broker organization code? | 3 | | Insurance broker name | MID ILLINOIS INSURANCE |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,585 | | Total amount of fees paid to insurance company | USD $19,329 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82768 C9283 |
| Policy instance | 4 |
| Insurance contract or identification number | 82768 C9283 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,935 | | Total amount of fees paid to insurance company | USD $128 | | Other welfare benefits provided | OTHER SUPPLEMENTAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $60,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,266 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400 P79705 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400 P79705 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $45,458 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P07400 P79705 |
| Policy instance | 1 |
| Insurance contract or identification number | P07400 P79705 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2009-03-01 | | Insurance policy end date | 2010-02-28 | | Total amount of commissions paid to insurance broker | USD $37,541 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
| Policy contract number | JW00190640 |
| Policy instance | 2 |
| Insurance contract or identification number | JW00190640 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,264 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 559943 |
| Policy instance | 3 |
| Insurance contract or identification number | 559943 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,188 | | Total amount of fees paid to insurance company | USD $13,487 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 83768 C9283 |
| Policy instance | 4 |
| Insurance contract or identification number | 83768 C9283 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,628 | | Total amount of fees paid to insurance company | USD $82 | | Other welfare benefits provided | OTHER SUPPLEMENTAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $54,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
