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LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 401k Plan overview

Plan NameLUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN
Plan identification number 501

LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

LUCKY SERVICES CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:LUCKY SERVICES CORPORATION
Employer identification number (EIN):456163751
NAIC Classification:213110
NAIC Description: Support Activities for Mining

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-03-01RITA SPENCER2023-09-07
5012021-03-01RITA SPENCER2022-11-02
5012020-03-01RITA SPENCER2021-09-30
5012019-03-01RITA SPENCER2020-09-18
5012018-03-01RITA SPENCER2019-09-05
5012017-03-01
5012016-03-01
5012015-03-01
5012014-03-01RITA SPENCER2016-12-22 RITA SPENCER2016-12-22
5012013-03-01RITA SPENCER2016-12-22 RITA SPENCER2016-12-22

Plan Statistics for LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN

401k plan membership statisitcs for LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN

Measure Date Value
2022: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-01139
Total number of active participants reported on line 7a of the Form 55002022-03-01175
Number of retired or separated participants receiving benefits2022-03-010
Number of other retired or separated participants entitled to future benefits2022-03-010
Total of all active and inactive participants2022-03-01175
Number of employers contributing to the scheme2022-03-010
2021: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-01106
Total number of active participants reported on line 7a of the Form 55002021-03-01139
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-01139
Number of employers contributing to the scheme2021-03-010
2020: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-01115
Total number of active participants reported on line 7a of the Form 55002020-03-01106
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01106
Number of employers contributing to the scheme2020-03-010
2019: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01175
Total number of active participants reported on line 7a of the Form 55002019-03-01115
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01115
Number of employers contributing to the scheme2019-03-010
2018: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01154
Total number of active participants reported on line 7a of the Form 55002018-03-01175
Total of all active and inactive participants2018-03-01175
2017: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01185
Total number of active participants reported on line 7a of the Form 55002017-03-01154
Total of all active and inactive participants2017-03-01154
2016: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01151
Total number of active participants reported on line 7a of the Form 55002016-03-01185
Total of all active and inactive participants2016-03-01185
2015: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-01166
Total number of active participants reported on line 7a of the Form 55002015-03-01151
Number of retired or separated participants receiving benefits2015-03-011
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01152
2014: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-0197
Total number of active participants reported on line 7a of the Form 55002014-03-01107
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01107
2013: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01102
Total number of active participants reported on line 7a of the Form 55002013-03-0195
Number of retired or separated participants receiving benefits2013-03-010
Number of other retired or separated participants entitled to future benefits2013-03-010
Total of all active and inactive participants2013-03-0195

Financial Data on LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN

Measure Date Value
2019 : LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2019 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-02-28No
Was this plan covered by a fidelity bond2019-02-28No
If this is an individual account plan, was there a blackout period2019-02-28No
Were there any nonexempt tranactions with any party-in-interest2019-02-28No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-02-28No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-02-28No
Were any loans by the plan or fixed income obligations due to the plan in default2019-02-28No
Were any leases to which the plan was party in default or uncollectible2019-02-28No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-02-28No
Was there a failure to transmit to the plan any participant contributions2019-02-28No
Has the plan failed to provide any benefit when due under the plan2019-02-28No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-02-28No
Did the plan have assets held for investment2019-02-28No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-02-28No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-02-28No
2018 : LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2018 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-02-28No
Was this plan covered by a fidelity bond2018-02-28No
If this is an individual account plan, was there a blackout period2018-02-28No
Were there any nonexempt tranactions with any party-in-interest2018-02-28No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-02-28No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-02-28No
Were any loans by the plan or fixed income obligations due to the plan in default2018-02-28No
Were any leases to which the plan was party in default or uncollectible2018-02-28No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-02-28No
Was there a failure to transmit to the plan any participant contributions2018-02-28No
Has the plan failed to provide any benefit when due under the plan2018-02-28No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-02-28No
Did the plan have assets held for investment2018-02-28No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-02-28No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-02-28No
2017 : LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2017 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-02-28No
Was this plan covered by a fidelity bond2017-02-28No
If this is an individual account plan, was there a blackout period2017-02-28No
Were there any nonexempt tranactions with any party-in-interest2017-02-28No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-02-28No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-02-28No
Were any loans by the plan or fixed income obligations due to the plan in default2017-02-28No
Were any leases to which the plan was party in default or uncollectible2017-02-28No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-02-28No
Was there a failure to transmit to the plan any participant contributions2017-02-28No
Has the plan failed to provide any benefit when due under the plan2017-02-28No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-02-28No
Did the plan have assets held for investment2017-02-28No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-02-28No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-02-28No
2016 : LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2016 401k financial data
Value of total assets at end of year2016-02-29$0
Value of total assets at beginning of year2016-02-29$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-02-29No
Was this plan covered by a fidelity bond2016-02-29No
If this is an individual account plan, was there a blackout period2016-02-29No
Were there any nonexempt tranactions with any party-in-interest2016-02-29No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-02-29No
Value of net assets at end of year (total assets less liabilities)2016-02-29$0
Value of net assets at beginning of year (total assets less liabilities)2016-02-29$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-02-29No
Were any loans by the plan or fixed income obligations due to the plan in default2016-02-29No
Were any leases to which the plan was party in default or uncollectible2016-02-29No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-02-29No
Was there a failure to transmit to the plan any participant contributions2016-02-29No
Has the plan failed to provide any benefit when due under the plan2016-02-29No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-02-29No
Assets. Value of buildings and other operty used in plan operation at end of year2016-02-29$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-02-29$0
Did the plan have assets held for investment2016-02-29No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-02-29No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-02-29No

Form 5500 Responses for LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN

2022: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – InsuranceYes
2021: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – General assets of the sponsorYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – General assets of the sponsorYes
2020: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – General assets of the sponsorYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – General assets of the sponsorYes
2019: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – General assets of the sponsorYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – General assets of the sponsorYes
2018: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – TrustYes
2018-03-01Plan funding arrangement – General assets of the sponsorYes
2018-03-01Plan benefit arrangement – InsuranceYes
2018-03-01Plan benefit arrangement - TrustYes
2017: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – TrustYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement - TrustYes
2016: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – TrustYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2016-03-01Plan benefit arrangement - TrustYes
2015: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Plan funding arrangement – TrustYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2015-03-01Plan benefit arrangement - TrustYes
2014: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – InsuranceYes
2014-03-01Plan benefit arrangement - TrustYes
2013: LUCKY SERVICES CORPORATION WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01First time form 5500 has been submittedYes
2013-03-01Plan funding arrangement – General assets of the sponsorYes
2013-03-01Plan benefit arrangement – InsuranceYes
2013-03-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number573088
Policy instance 2
Insurance contract or identification number573088
Number of Individuals Covered175
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $5,284
Total amount of fees paid to insurance companyUSD $529
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $28,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,284
Amount paid for insurance broker fees529
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number920968
Policy instance 1
Insurance contract or identification number920968
Number of Individuals Covered324
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $8,827
Total amount of fees paid to insurance companyUSD $54,056
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,373,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,827
Amount paid for insurance broker fees52213
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number920968
Policy instance 2
Insurance contract or identification number920968
Number of Individuals Covered340
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $6,417
Total amount of fees paid to insurance companyUSD $45,592
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,162,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,417
Amount paid for insurance broker fees42103
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number573088
Policy instance 1
Insurance contract or identification number573088
Number of Individuals Covered139
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $3,964
Total amount of fees paid to insurance companyUSD $424
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,964
Amount paid for insurance broker fees424
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number920968
Policy instance 2
Insurance contract or identification number920968
Number of Individuals Covered300
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $7,059
Total amount of fees paid to insurance companyUSD $49,314
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,243,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,059
Amount paid for insurance broker fees49314
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number573088
Policy instance 1
Insurance contract or identification number573088
Number of Individuals Covered106
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $3,540
Total amount of fees paid to insurance companyUSD $320
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $19,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,540
Amount paid for insurance broker fees320
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1034198
Policy instance 3
Insurance contract or identification number1034198
Number of Individuals Covered42
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $784
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $590
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberGFZ01637
Policy instance 2
Insurance contract or identification numberGFZ01637
Number of Individuals Covered15
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $1,560
Total amount of fees paid to insurance companyUSD $320
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,020
Insurance broker organization code?3
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-039585
Policy instance 1
Insurance contract or identification number010-039585
Number of Individuals Covered253
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $4,375
Total amount of fees paid to insurance companyUSD $2,488
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,375
Amount paid for insurance broker fees2488
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number188043
Policy instance 1
Insurance contract or identification number188043
Number of Individuals Covered175
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $25,940
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedAGGREGATE HEALTH STOP LOSS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,940
Additional information about fees paid to insurance brokerBASE COMMISSIONS PAID
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberPOL# 1000297
Policy instance 2
Insurance contract or identification numberPOL# 1000297
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberPOL# 1000297
Policy instance 2
Insurance contract or identification numberPOL# 1000297
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number188043
Policy instance 1
Insurance contract or identification number188043
Number of Individuals Covered154
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $27,020
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedAGGREGATE HEALTH STOP LOSS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,020
Additional information about fees paid to insurance brokerBASE COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberPOL# NUTA-1264
Policy instance 1
Insurance contract or identification numberPOL# NUTA-1264
Number of Individuals Covered151
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $377,462
Total amount of fees paid to insurance companyUSD $18,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $377,462
Amount paid for insurance broker fees18556
Additional information about fees paid to insurance brokerPPO AND PRE-CERTIFICATION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberPOL# 1000297
Policy instance 2
Insurance contract or identification numberPOL# 1000297
Number of Individuals Covered151
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $15,952
Total amount of fees paid to insurance companyUSD $84,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,952
Amount paid for insurance broker fees84365
Additional information about fees paid to insurance brokerDENTAL AND VISION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberPOL# 1000297
Policy instance 2
Insurance contract or identification numberPOL# 1000297
Number of Individuals Covered107
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $10,019
Total amount of fees paid to insurance companyUSD $48,294
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,019
Amount paid for insurance broker fees48294
Additional information about fees paid to insurance brokerDENTAL AND VISION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberPOL# NUTA-1264
Policy instance 1
Insurance contract or identification numberPOL# NUTA-1264
Number of Individuals Covered107
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $273,977
Total amount of fees paid to insurance companyUSD $11,844
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $273,977
Amount paid for insurance broker fees11844
Additional information about fees paid to insurance brokerPPO AND PRE-CERTIFICATION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberPOL# 1000297
Policy instance 2
Insurance contract or identification numberPOL# 1000297
Number of Individuals Covered95
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $8,576
Total amount of fees paid to insurance companyUSD $41,534
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,576
Amount paid for insurance broker fees41534
Additional information about fees paid to insurance brokerDENTAL AND VISION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberPOL# NUTA-1264
Policy instance 1
Insurance contract or identification numberPOL# NUTA-1264
Number of Individuals Covered95
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $238,347
Total amount of fees paid to insurance companyUSD $8,896
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $238,347
Amount paid for insurance broker fees8896
Additional information about fees paid to insurance brokerPPO AND PRE-CERTIFICATION
Insurance broker organization code?3
Insurance broker nameMCANALLY WILKINS INSURANCE

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