SOUTHWEST TENNESSEE EMC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-09-01 | 391 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-09-01 | 470 |
| Number of retired or separated participants receiving benefits | 2022-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-09-01 | 0 |
| Total of all active and inactive participants | 2022-09-01 | 470 |
| 2021: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 394 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 393 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 393 |
| 2020: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 392 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 392 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 392 |
| 2019: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 370 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 370 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
| Total of all active and inactive participants | 2019-09-01 | 370 |
| 2018: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 371 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 371 |
| 2017: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 0 |
| Total participants, beginning-of-year | 2017-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 99 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 99 |
| 2016: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 0 |
| Total participants, beginning-of-year | 2016-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 101 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 101 |
| 2015: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 0 |
| 2022: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SOUTHWEST TENNESSEE EMC WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | First time form 5500 has been submitted | Yes |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 4 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $10,383 | | Total amount of fees paid to insurance company | USD $1,298 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,734 | | Amount paid for insurance broker fees | 1298 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $4,629 | | Total amount of fees paid to insurance company | USD $50 | | Welfare Benefit Premiums Paid to Carrier | USD $48,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,099 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 50 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $10,954 | | Total amount of fees paid to insurance company | USD $1,369 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $68,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,269 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1369 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $137,425 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,628,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $137,425 | | Additional information about fees paid to insurance broker | ACQ/RET | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 393 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $129,110 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,460,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97,980 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $23,388 | | Total amount of fees paid to insurance company | USD $2,761 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,708 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2761 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $4,098 | | Total amount of fees paid to insurance company | USD $49 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,624 | | Amount paid for insurance broker fees | 11 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $3,861 | | Welfare Benefit Premiums Paid to Carrier | USD $54,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,287 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $21,848 | | Total amount of fees paid to insurance company | USD $2,651 | | Welfare Benefit Premiums Paid to Carrier | USD $132,547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,882 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2651 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $122,544 | | Welfare Benefit Premiums Paid to Carrier | USD $2,340,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $122,544 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,789 | | Total amount of fees paid to insurance company | USD $3 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,213 | | Amount paid for insurance broker fees | 3 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $20,641 | | Total amount of fees paid to insurance company | USD $2,499 | | Welfare Benefit Premiums Paid to Carrier | USD $124,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,742 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2499 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 370 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $113,351 | | Welfare Benefit Premiums Paid to Carrier | USD $2,321,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $113,351 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $21,904 | | Total amount of fees paid to insurance company | USD $2,575 | | Welfare Benefit Premiums Paid to Carrier | USD $128,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,316 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2575 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $128,634 | | Welfare Benefit Premiums Paid to Carrier | USD $2,231,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $128,634 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $5,252 | | Total amount of fees paid to insurance company | USD $9 | | Welfare Benefit Premiums Paid to Carrier | USD $53,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,279 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 9 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 1 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $113,688 | | Welfare Benefit Premiums Paid to Carrier | USD $2,175,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 2 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $18,312 | | Total amount of fees paid to insurance company | USD $2,289 | | Welfare Benefit Premiums Paid to Carrier | USD $114,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 3 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $4,591 | | Welfare Benefit Premiums Paid to Carrier | USD $56,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E8099772 |
| Policy instance | 4 |
| Insurance contract or identification number | E8099772 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $7,043 | | Total amount of fees paid to insurance company | USD $511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 422 | | Insurance broker name | MOORE INS OF BROWNSVILLE LLC |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001054 |
| Policy instance | 3 |
| Insurance contract or identification number | 50001054 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $26,500 | | Total amount of fees paid to insurance company | USD $3,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,266 | | Amount paid for insurance broker fees | 3231 | | Insurance broker organization code? | 3 | | Insurance broker name | V E PENNEL |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 112000 |
| Policy instance | 2 |
| Insurance contract or identification number | 112000 | | Number of Individuals Covered | 388 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $16,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,282 | | Insurance broker organization code? | 3 | | Insurance broker name | V E PENNEL, JR. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0838030 |
| Policy instance | 1 |
| Insurance contract or identification number | 0838030 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $14,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,900 | | Insurance broker organization code? | 3 | | Insurance broker name | VIRGIL E. PENNEL JR |
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