GENESIS PHYSICIANS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212
401k plan membership statisitcs for THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212
| Measure | Date | Value |
|---|
| 2021: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 49 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 49 |
| 2020: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 64 |
| Total of all active and inactive participants | 2020-01-01 | 64 |
| 2019: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 68 |
| Total of all active and inactive participants | 2019-01-01 | 68 |
| 2018: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 104 |
| Total of all active and inactive participants | 2018-01-01 | 104 |
| 2017: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 226 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 239 |
| Total of all active and inactive participants | 2017-01-01 | 239 |
| 2016: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 226 |
| Total of all active and inactive participants | 2016-01-01 | 226 |
| 2015: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 249 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 244 |
| Total of all active and inactive participants | 2015-01-01 | 244 |
| 2014: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 249 |
| Total of all active and inactive participants | 2014-01-01 | 249 |
| 2013: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 340 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 287 |
| Total of all active and inactive participants | 2013-01-01 | 287 |
| 2012: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 340 |
| Total of all active and inactive participants | 2012-01-01 | 340 |
| 2011: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 488 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 422 |
| Total of all active and inactive participants | 2011-01-01 | 422 |
| 2010: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 488 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 488 |
| Total of all active and inactive participants | 2010-01-01 | 488 |
| 2009: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 271 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 488 |
| Total of all active and inactive participants | 2009-01-01 | 488 |
| 2021: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Mulitple employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Mulitple employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Mulitple employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Mulitple employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: THE GENESIS PHYSICIANS, INC. EMPLOYEE BENEFIT PLAN 102 MAIN STREET, SUITE 228 LAGRANGE, GA 30240-3212 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Mulitple employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,272 | | Total amount of fees paid to insurance company | USD $573 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,272 | | Amount paid for insurance broker fees | 573 | | Additional information about fees paid to insurance broker | SALES COMMISSIONS INSURANCE FEES |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0672 |
| Policy instance | 1 |
| Insurance contract or identification number | GB0672 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $10,186 | | Total amount of fees paid to insurance company | USD $2,946 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $295,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,186 | | Amount paid for insurance broker fees | 2946 | | Additional information about fees paid to insurance broker | SALES COMMISSIONS INSURANCE FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0672 |
| Policy instance | 1 |
| Insurance contract or identification number | GB0672 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $27,026 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,026 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GB0672 |
| Policy instance | 3 |
| Insurance contract or identification number | GB0672 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $6,265 | | Total amount of fees paid to insurance company | USD $1,207 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,265 | | Amount paid for insurance broker fees | 1207 | | Insurance broker organization code? | 3 |
|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) |
| Policy contract number | 797405 |
| Policy instance | 1 |
| Insurance contract or identification number | 797405 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $47,060 | | Total amount of fees paid to insurance company | USD $1,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,060 | | Amount paid for insurance broker fees | 1176 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $9,225 | | Total amount of fees paid to insurance company | USD $3,448 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,225 | | Amount paid for insurance broker fees | 3448 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 797405 |
| Policy instance | 3 |
| Insurance contract or identification number | 797405 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $7,797 | | Total amount of fees paid to insurance company | USD $1,445 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,797 | | Amount paid for insurance broker fees | 1445 | | Additional information about fees paid to insurance broker | BONUSES | | Insurance broker organization code? | 3 |
|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) |
| Policy contract number | 797405 |
| Policy instance | 1 |
| Insurance contract or identification number | 797405 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $61,234 | | Total amount of fees paid to insurance company | USD $1,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,234 | | Amount paid for insurance broker fees | 1017 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 797405 |
| Policy instance | 3 |
| Insurance contract or identification number | 797405 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $9,451 | | Total amount of fees paid to insurance company | USD $189 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,451 | | Amount paid for insurance broker fees | 189 |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $8,765 | | Total amount of fees paid to insurance company | USD $1,003 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,765 | | Amount paid for insurance broker fees | 1003 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6983 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $54,719 | | Total amount of fees paid to insurance company | USD $199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,239 | | Amount paid for insurance broker fees | 199 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6983 |
| Policy instance | 3 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $7,055 | | Total amount of fees paid to insurance company | USD $3,197 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,149 | | Amount paid for insurance broker fees | 3197 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 496497 |
| Policy instance | 4 |
| Insurance contract or identification number | 496497 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $5,250 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,250 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6983 |
| Policy instance | 3 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | 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 name | J. SMITH LANIER & CO. |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6983 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $68,957 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,957 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $9,653 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,653 | | Insurance broker organization code? | 3 | | Insurance broker name | DESMOND E. JOINER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 496497 |
| Policy instance | 4 |
| Insurance contract or identification number | 496497 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $4,313 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,313 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA6983 |
| Policy instance | 3 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | 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 name | J. SMITH LANIER & CO. |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $8,339 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,504 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | GA6983 |
| Policy instance | 1 |
| Insurance contract or identification number | GA6983 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $64,148 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,148 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1025818000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1025818000 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $177 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $177 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
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| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $9,116 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,116 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA5384 |
| Policy instance | 3 |
| Insurance contract or identification number | GA5384 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $116 | | Total amount of fees paid to insurance company | USD $69 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,249 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $116 | | Amount paid for insurance broker fees | 69 | | Additional information about fees paid to insurance broker | INCENTIVE, EDUCATION, COMMUNICATION AND TRAINING | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1025818000 |
| Policy instance | 4 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $1,806 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,806 | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 744070 |
| Policy instance | 6 |
| Insurance contract or identification number | 744070 | | Number of Individuals Covered | 283 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $87,594 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,499,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 87594 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 60054 |
| Policy instance | 5 |
| Insurance contract or identification number | 60054 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $5,376 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,703 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,376 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $8,967 | | Total amount of fees paid to insurance company | USD $950 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,717 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,967 | | Amount paid for insurance broker fees | 950 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA5384 |
| Policy instance | 3 |
| Insurance contract or identification number | GA5384 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $233 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,181 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $233 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1025818000 |
| Policy instance | 4 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,414 | | 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 name | |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 744070 |
| Policy instance | 6 |
| Insurance contract or identification number | 744070 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $77,067 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,621,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,067 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1025818000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $8,180 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,180 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER & CO. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 509323 |
| Policy instance | 5 |
| Insurance contract or identification number | 509323 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $5,037 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,037 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA5384 |
| Policy instance | 3 |
| Insurance contract or identification number | GA5384 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $25,445 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $443,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1025818000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $77,646 | | Total amount of fees paid to insurance company | USD $2,636 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $605,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $9,114 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
| Policy contract number | 1025818000 |
| Policy instance | 4 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 220 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,047,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
| Policy contract number | GA0558 |
| Policy instance | 2 |
| Insurance contract or identification number | GA0558 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $8,912 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,912 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | GA5384 |
| Policy instance | 3 |
| Insurance contract or identification number | GA5384 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $51,230 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,230 | | Insurance broker name | J. SMITH LANIER |
|
| BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
| Policy contract number | 1025818000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1025818000 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $50,826 | | Total amount of fees paid to insurance company | USD $9,433 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $816,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,826 | | Amount paid for insurance broker fees | 9433 | | Insurance broker organization code? | 3 | | Insurance broker name | J. SMITH LANIER |
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