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BARKLEY, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan NameBARKLEY, INC. HEALTH & WELFARE PLAN
Plan identification number 502

BARKLEY, INC. HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BARKLEY, INC. has sponsored the creation of one or more 401k plans.

Company Name:BARKLEY, INC.
Employer identification number (EIN):431028307
NAIC Classification:541800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARKLEY, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01AMY ALLEN
5022016-01-01AMY ALLEN
5022015-01-01AMY ALLEN
5022014-03-01AMY ALLEN
5022013-03-01AMY ALLEN
5022012-03-01KAY MOORE
5022011-03-01KAY MOORE
5022010-03-01KAY MOORE
5022009-03-01KAY MOORE

Plan Statistics for BARKLEY, INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for BARKLEY, INC. HEALTH & WELFARE PLAN

Measure Date Value
2022: BARKLEY, INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01435
Total number of active participants reported on line 7a of the Form 55002022-01-01424
Number of retired or separated participants receiving benefits2022-01-013
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01427
2021: BARKLEY, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01415
Total number of active participants reported on line 7a of the Form 55002021-01-01431
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01435
2020: BARKLEY, INC. HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01339
Total number of active participants reported on line 7a of the Form 55002020-01-01414
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01415
2019: BARKLEY, INC. HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01330
Total number of active participants reported on line 7a of the Form 55002019-01-01337
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01339
2018: BARKLEY, INC. HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01366
Total number of active participants reported on line 7a of the Form 55002018-01-01324
Number of retired or separated participants receiving benefits2018-01-016
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01330
2017: BARKLEY, INC. HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01396
Total number of active participants reported on line 7a of the Form 55002017-01-01356
Number of retired or separated participants receiving benefits2017-01-0110
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01366
2016: BARKLEY, INC. HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01362
Total number of active participants reported on line 7a of the Form 55002016-01-01396
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01396
2015: BARKLEY, INC. HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01314
Total number of active participants reported on line 7a of the Form 55002015-01-01362
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01362
2014: BARKLEY, INC. HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01273
Total number of active participants reported on line 7a of the Form 55002014-03-01313
Number of retired or separated participants receiving benefits2014-03-011
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01314
2013: BARKLEY, INC. HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01207
Total number of active participants reported on line 7a of the Form 55002013-03-01272
Number of retired or separated participants receiving benefits2013-03-011
Total of all active and inactive participants2013-03-01273
2012: BARKLEY, INC. HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01193
Total number of active participants reported on line 7a of the Form 55002012-03-01203
Number of retired or separated participants receiving benefits2012-03-014
Total of all active and inactive participants2012-03-01207
2011: BARKLEY, INC. HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01155
Total number of active participants reported on line 7a of the Form 55002011-03-01193
Number of retired or separated participants receiving benefits2011-03-015
Total of all active and inactive participants2011-03-01198
2010: BARKLEY, INC. HEALTH & WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-01299
Total number of active participants reported on line 7a of the Form 55002010-03-01155
Number of retired or separated participants receiving benefits2010-03-0121
Total of all active and inactive participants2010-03-01176
2009: BARKLEY, INC. HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-01321
Total number of active participants reported on line 7a of the Form 55002009-03-01281
Number of retired or separated participants receiving benefits2009-03-0118
Number of other retired or separated participants entitled to future benefits2009-03-010
Total of all active and inactive participants2009-03-01299

Form 5500 Responses for BARKLEY, INC. HEALTH & WELFARE PLAN

2022: BARKLEY, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BARKLEY, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BARKLEY, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: BARKLEY, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: BARKLEY, INC. HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: BARKLEY, INC. HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: BARKLEY, INC. HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BARKLEY, INC. HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BARKLEY, INC. HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: BARKLEY, INC. HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: BARKLEY, INC. HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: BARKLEY, INC. HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: BARKLEY, INC. HEALTH & WELFARE PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: BARKLEY, INC. HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 966592
Policy instance 5
Insurance contract or identification numberLK 966592
Number of Individuals Covered531
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,291
Total amount of fees paid to insurance companyUSD $1,058
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,291
Insurance broker organization code?3
Amount paid for insurance broker fees1058
Additional information about fees paid to insurance brokerGENERAL AGENCY FEES
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered625
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $53,108
Total amount of fees paid to insurance companyUSD $39,365
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,108
Amount paid for insurance broker fees39365
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered309
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,520
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,520
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered424
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,918
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $251,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,918
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969945
Policy instance 4
Insurance contract or identification numberFLX969945
Number of Individuals Covered610
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,573
Total amount of fees paid to insurance companyUSD $1,551
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,699
Insurance broker organization code?3
Amount paid for insurance broker fees1551
Additional information about fees paid to insurance brokerGENERAL AGENCY FEES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 971387
Policy instance 10
Insurance contract or identification numberOK 971387
Number of Individuals Covered531
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $772
Total amount of fees paid to insurance companyUSD $193
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $772
Insurance broker organization code?3
Amount paid for insurance broker fees193
Additional information about fees paid to insurance brokerGENERAL AGENCY FEES
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587902
Policy instance 6
Insurance contract or identification number035587902
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $39
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered58
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,388
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $156,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,388
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 8
Insurance contract or identification number035587306
Number of Individuals Covered28
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,477
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,477
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587901
Policy instance 9
Insurance contract or identification number035587901
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $117
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered519
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $47,501
Total amount of fees paid to insurance companyUSD $37,685
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,501
Amount paid for insurance broker fees37685
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered312
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,526
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,526
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered341
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,082
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,082
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered431
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,026
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,796
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered431
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,655
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,546
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587902
Policy instance 6
Insurance contract or identification number035587902
Number of Individuals Covered2
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $176
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $176
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered29
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,920
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,920
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 8
Insurance contract or identification number035587306
Number of Individuals Covered17
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,925
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,925
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587901
Policy instance 9
Insurance contract or identification number035587901
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $20
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $-957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered508
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $43,850
Total amount of fees paid to insurance companyUSD $32,435
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,850
Amount paid for insurance broker fees32435
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered306
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,357
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,357
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered326
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,382
Total amount of fees paid to insurance companyUSD $1,746
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,382
Amount paid for insurance broker fees1746
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered414
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,299
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,126
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered414
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,770
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,685
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587304
Policy instance 6
Insurance contract or identification number035587304
Number of Individuals Covered42
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,914
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $240,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,914
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,541
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,541
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 8
Insurance contract or identification number035587306
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,073
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,073
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587301
Policy instance 9
Insurance contract or identification number035587301
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $156
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $156
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587901
Policy instance 11
Insurance contract or identification number035587901
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $39
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587307
Policy instance 10
Insurance contract or identification number035587307
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $20
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered246
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,305
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,305
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered415
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $37,273
Total amount of fees paid to insurance companyUSD $26,040
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,273
Amount paid for insurance broker fees26040
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered337
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,099
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,019
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered337
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,229
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,063
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587304
Policy instance 6
Insurance contract or identification number035587304
Number of Individuals Covered54
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,675
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $232,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,675
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $975
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $975
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 8
Insurance contract or identification number035587306
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $683
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $683
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered257
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,757
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,757
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered324
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,443
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,259
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587304
Policy instance 6
Insurance contract or identification number035587304
Number of Individuals Covered42
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,661
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $215,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,764
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered324
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,792
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,730
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered6
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $898
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $800
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587301
Policy instance 8
Insurance contract or identification number035587301
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $566
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $566
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587900
Policy instance 10
Insurance contract or identification number035587900
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,689
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,689
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered256
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,344
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,344
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered234
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,346
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,346
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered397
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $41,681
Total amount of fees paid to insurance companyUSD $27,470
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,681
Amount paid for insurance broker fees27470
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 9
Insurance contract or identification number035587306
Number of Individuals Covered3
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $351
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $312
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered475
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $46,024
Total amount of fees paid to insurance companyUSD $29,940
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid in cash?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,024
Amount paid for insurance broker fees29940
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered264
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,412
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,412
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered289
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,002
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $202,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,002
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered356
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $10,012
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,211
Insurance broker organization code?3
Insurance broker nameC2 CENTRIC LLC
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587304
Policy instance 6
Insurance contract or identification number035587304
Number of Individuals Covered41
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,573
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,613
Insurance broker organization code?3
Insurance broker nameNEISHLOSS & FLEMING
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered356
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,751
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,171
Insurance broker organization code?3
Insurance broker nameC2 CENTRIC LLC
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587300
Policy instance 7
Insurance contract or identification number035587300
Number of Individuals Covered6
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,125
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $585
Insurance broker organization code?3
Insurance broker nameNEISHLOSS & FLEMING
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587301
Policy instance 8
Insurance contract or identification number035587301
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $20
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20
Insurance broker organization code?3
Insurance broker nameNEISHLOSS & FLEMING
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number035587306
Policy instance 9
Insurance contract or identification number035587306
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $78
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $78
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOICATES, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 4
Insurance contract or identification number158868
Number of Individuals Covered362
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $11,524
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,130
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS SERVICES GROUP
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 3
Insurance contract or identification number3336948
Number of Individuals Covered264
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,003
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $177,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,003
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered256
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,102
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,102
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, LLC
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered461
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $45,600
Total amount of fees paid to insurance companyUSD $26,439
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,600
Amount paid for insurance broker fees26439
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number158868
Policy instance 5
Insurance contract or identification number158868
Number of Individuals Covered362
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,294
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,834
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS SERVICES GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53193
Policy instance 2
Insurance contract or identification number53193
Number of Individuals Covered313
Insurance policy start date2014-03-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,937
Total amount of fees paid to insurance companyUSD $88
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $79,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,150
Insurance broker organization code?3
Amount paid for insurance broker fees88
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered454
Insurance policy start date2014-03-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,438
Total amount of fees paid to insurance companyUSD $17,689
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,438
Amount paid for insurance broker fees7457
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 3
Insurance contract or identification number12235178
Number of Individuals Covered219
Insurance policy start date2014-03-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $641
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $641
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 4
Insurance contract or identification number3336948
Number of Individuals Covered228
Insurance policy start date2014-03-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,264
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,264
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY AND ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 3
Insurance contract or identification number12235178
Number of Individuals Covered188
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $1,462
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,462
Insurance broker organization code?3
Insurance broker nameROBERT E. MILLER INSURANCE AGENCY
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered412
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $43,045
Total amount of fees paid to insurance companyUSD $20,116
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,045
Amount paid for insurance broker fees20116
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameROBERT E. MILLER
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336948
Policy instance 4
Insurance contract or identification number3336948
Number of Individuals Covered212
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $172,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53193
Policy instance 2
Insurance contract or identification number53193
Number of Individuals Covered272
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $12,383
Total amount of fees paid to insurance companyUSD $107
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $99,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,876
Insurance broker organization code?3
Amount paid for insurance broker fees107
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 2
Insurance contract or identification number12235178
Number of Individuals Covered206
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53193
Policy instance 3
Insurance contract or identification number53193
Number of Individuals Covered529
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $14,387
Total amount of fees paid to insurance companyUSD $91
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $240,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,896
Amount paid for insurance broker fees91
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameROBERT E MILLER INSURANCE AGENCY
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered438
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $37,408
Total amount of fees paid to insurance companyUSD $18,167
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid in cash?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,557
Amount paid for insurance broker fees13253
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameROBERT E MILLER
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53193
Policy instance 6
Insurance contract or identification number53193
Number of Individuals Covered237
Insurance policy start date2011-05-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $15,568
Total amount of fees paid to insurance companyUSD $65
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 4
Insurance contract or identification number12235178
Number of Individuals Covered188
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $1,380
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-0937-00
Policy instance 3
Insurance contract or identification number454-0937-00
Number of Individuals Covered217
Insurance policy start date2011-03-01
Insurance policy end date2011-05-01
Total amount of commissions paid to insurance brokerUSD $412
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05575894
Policy instance 2
Insurance contract or identification numberKM05575894
Number of Individuals Covered381
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,497
Total amount of fees paid to insurance companyUSD $67
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $26,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered434
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $35,946
Total amount of fees paid to insurance companyUSD $17,100
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberBGGR096450
Policy instance 5
Insurance contract or identification numberBGGR096450
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of fees paid to insurance companyUSD $39
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05575894
Policy instance 2
Insurance contract or identification numberKM05575894
Number of Individuals Covered425
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $7,177
Total amount of fees paid to insurance companyUSD $3,541
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $195,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,849
Amount paid for insurance broker fees3541
Additional information about fees paid to insurance brokerNON MONETARY SUPP COMPENSATION
Insurance broker organization code?3
Insurance broker nameSRA BENEFITS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberBGGR096450
Policy instance 5
Insurance contract or identification numberBGGR096450
Number of Individuals Covered184
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $2,650
Total amount of fees paid to insurance companyUSD $202
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,605
Insurance broker organization code?3
Amount paid for insurance broker fees202
Additional information about fees paid to insurance brokerNONMONETARY COMPSUPP COMP
Insurance broker nameWILLIS OF GREATER KANSAS, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12235178
Policy instance 4
Insurance contract or identification number12235178
Number of Individuals Covered197
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $1,470
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,347
Insurance broker organization code?3
Insurance broker nameSRA BENEFITS
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number11589000
Policy instance 1
Insurance contract or identification number11589000
Number of Individuals Covered408
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $18,599
Total amount of fees paid to insurance companyUSD $32,671
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,251
Amount paid for insurance broker fees31366
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameSRA BENEFITS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-0937-00
Policy instance 3
Insurance contract or identification number454-0937-00
Number of Individuals Covered220
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $4,082
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,777
Insurance broker organization code?3
Insurance broker nameCLAY JAMES/ SRA BENEFITS

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