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CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 401k Plan overview

Plan NameCHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN
Plan identification number 501

CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

CHUCK HUTTON CHEVROLET COMPANY CAFETERIA has sponsored the creation of one or more 401k plans.

Company Name:CHUCK HUTTON CHEVROLET COMPANY CAFETERIA
Employer identification number (EIN):620907139
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-08-01
5012020-08-01
5012019-08-01
5012018-08-01
5012017-08-01
5012016-08-01RICHARD CARNEY RICHARD CARNEY2018-02-26
5012015-08-01RICHARD CARNEY
5012014-08-01RICHARD CARNEY
5012013-08-01RICHARD CARNEY
5012012-08-01RICHARD CARNEY
5012011-08-01RICHARD CARNEY
5012010-08-01RICHARD CARNEY
5012009-08-01RICHARD CARNEY
5012008-08-01

Plan Statistics for CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN

401k plan membership statisitcs for CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN

Measure Date Value
2021: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01292
Total number of active participants reported on line 7a of the Form 55002021-08-01281
Total of all active and inactive participants2021-08-01281
2020: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01323
Total number of active participants reported on line 7a of the Form 55002020-08-01292
Total of all active and inactive participants2020-08-01292
2019: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01289
Total number of active participants reported on line 7a of the Form 55002019-08-01323
Total of all active and inactive participants2019-08-01323
2018: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01302
Total number of active participants reported on line 7a of the Form 55002018-08-01289
Total of all active and inactive participants2018-08-01289
2017: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01343
Total number of active participants reported on line 7a of the Form 55002017-08-01302
Total of all active and inactive participants2017-08-01302
2016: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01204
Total number of active participants reported on line 7a of the Form 55002016-08-01343
Total of all active and inactive participants2016-08-01343
2015: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01209
Total number of active participants reported on line 7a of the Form 55002015-08-01204
Total of all active and inactive participants2015-08-01204
2014: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01203
Total number of active participants reported on line 7a of the Form 55002014-08-01209
Total of all active and inactive participants2014-08-01209
2013: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01232
Total number of active participants reported on line 7a of the Form 55002013-08-01196
Total of all active and inactive participants2013-08-01196
2012: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01122
Total number of active participants reported on line 7a of the Form 55002012-08-01232
Number of retired or separated participants receiving benefits2012-08-010
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01232
2011: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01123
Total number of active participants reported on line 7a of the Form 55002011-08-01122
Total of all active and inactive participants2011-08-01122
2010: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year2010-08-01114
Total number of active participants reported on line 7a of the Form 55002010-08-01123
Number of retired or separated participants receiving benefits2010-08-010
Number of other retired or separated participants entitled to future benefits2010-08-010
Total of all active and inactive participants2010-08-01123
2009: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01123
Total number of active participants reported on line 7a of the Form 55002009-08-01114
Total of all active and inactive participants2009-08-01114

Form 5500 Responses for CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN

2021: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – InsuranceYes
2020: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – InsuranceYes
2019: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – InsuranceYes
2018: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – InsuranceYes
2017: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2010: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – InsuranceYes
2009: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01This submission is the final filingNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes
2008: CHUCK HUTTON CHEVROLET CO. CAFETERIA PLAN 2008 form 5500 responses
2008-08-01Type of plan entitySingle employer plan
2008-08-01Submission has been amendedNo
2008-08-01This submission is the final filingNo
2008-08-01This return/report is a short plan year return/report (less than 12 months)No
2008-08-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberKNG75
Policy instance 6
Insurance contract or identification numberKNG75
Number of Individuals Covered73
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $11,901
Total amount of fees paid to insurance companyUSD $78
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,949
Amount paid for insurance broker fees53
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract numberP3068
Policy instance 5
Insurance contract or identification numberP3068
Number of Individuals Covered98
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $49,640
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,640
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00633201
Policy instance 4
Insurance contract or identification number00633201
Number of Individuals Covered134
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $7,316
Total amount of fees paid to insurance companyUSD $38,164
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,316
Amount paid for insurance broker fees38164
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 3
Insurance contract or identification number82-2723296
Number of Individuals Covered74
Insurance policy start date2021-12-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $6,060
Total amount of fees paid to insurance companyUSD $32
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,153
Amount paid for insurance broker fees26
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number8100578326
Policy instance 2
Insurance contract or identification number8100578326
Number of Individuals Covered183
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $17,211
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,184
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number912062
Policy instance 1
Insurance contract or identification number912062
Number of Individuals Covered281
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $4,178
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,178
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number912062
Policy instance 1
Insurance contract or identification number912062
Number of Individuals Covered292
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $4,068
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,068
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number8100578326
Policy instance 2
Insurance contract or identification number8100578326
Number of Individuals Covered188
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $12,700
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,700
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 3
Insurance contract or identification number82-2723296
Number of Individuals Covered156
Insurance policy start date2020-12-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $19,256
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,687
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number137075
Policy instance 4
Insurance contract or identification number137075
Number of Individuals Covered219
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $39,808
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,808
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract numberP3068
Policy instance 5
Insurance contract or identification numberP3068
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number912062
Policy instance 1
Insurance contract or identification number912062
Number of Individuals Covered325
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $4,289
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,847
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number8100578326
Policy instance 2
Insurance contract or identification number8100578326
Number of Individuals Covered185
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $13,029
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,126
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 3
Insurance contract or identification number82-2723296
Number of Individuals Covered156
Insurance policy start date2019-12-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $19,374
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,687
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number137075
Policy instance 4
Insurance contract or identification number137075
Number of Individuals Covered238
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $38,457
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,298
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract numberP3068
Policy instance 5
Insurance contract or identification numberP3068
Number of Individuals Covered132
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $44,819
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,819
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract numberP3068
Policy instance 5
Insurance contract or identification numberP3068
Number of Individuals Covered134
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $79,933
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $79,933
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number137075
Policy instance 4
Insurance contract or identification number137075
Number of Individuals Covered246
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $35,517
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,622
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number58-0663085
Policy instance 3
Insurance contract or identification number58-0663085
Number of Individuals Covered151
Insurance policy start date2018-12-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $24,777
Total amount of fees paid to insurance companyUSD $905
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,095
Insurance broker organization code?3
Amount paid for insurance broker fees667
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number8100578326
Policy instance 2
Insurance contract or identification number8100578326
Number of Individuals Covered191
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $13,274
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,274
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number912062
Policy instance 1
Insurance contract or identification number912062
Number of Individuals Covered204
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $3,928
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,553
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number137075
Policy instance 4
Insurance contract or identification number137075
Number of Individuals Covered186
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $34,977
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number58-0663085
Policy instance 3
Insurance contract or identification number58-0663085
Number of Individuals Covered136
Insurance policy start date2017-12-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05938314
Policy instance 2
Insurance contract or identification numberTM05938314
Number of Individuals Covered302
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $4,433
Total amount of fees paid to insurance companyUSD $779
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUD0ABAR
Policy instance 1
Insurance contract or identification numberGUD0ABAR
Number of Individuals Covered206
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $4,501
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number126479
Policy instance 1
Insurance contract or identification number126479
Number of Individuals Covered196
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $44,597
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees44597
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
Insurance broker nameJAMES DABNEY COLLIER III
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberW1239
Policy instance 5
Insurance contract or identification numberW1239
Number of Individuals Covered47
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $11,786
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,699
Insurance broker organization code?3
Insurance broker nameCHUCK HUTTON INSURANCE GROUP LLC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberW1238
Policy instance 4
Insurance contract or identification numberW1238
Number of Individuals Covered110
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $34,280
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,589
Insurance broker organization code?3
Insurance broker nameCHUCK HUTTON ISURANCE GROUP LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 2
Insurance contract or identification numberG000ABAR
Number of Individuals Covered233
Insurance policy start date2013-10-01
Insurance policy end date2014-10-01
Total amount of commissions paid to insurance brokerUSD $5,729
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,729
Insurance broker organization code?3
Insurance broker nameJAS. D. COLLIER & CO.
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number126479
Policy instance 1
Insurance contract or identification number126479
Number of Individuals Covered196
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $38,316
Total amount of fees paid to insurance companyUSD $38,316
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees38316
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
Insurance broker nameJAMES DABNEY COLLIER III
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 3
Insurance contract or identification numberG000ABAR
Number of Individuals Covered234
Insurance policy start date2013-10-01
Insurance policy end date2014-10-01
Total amount of commissions paid to insurance brokerUSD $5,339
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG TERM DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,339
Insurance broker organization code?3
Insurance broker nameJAS. D. COLLIER & CO.
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number126479
Policy instance 1
Insurance contract or identification number126479
Number of Individuals Covered177
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $36,492
Total amount of fees paid to insurance companyUSD $36,492
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $588,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees36492
Additional information about fees paid to insurance brokerACQ/RET
Insurance broker organization code?3
Insurance broker nameJAMES DABNEY COLLIER III
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 3
Insurance contract or identification numberG000ABAR
Number of Individuals Covered70
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $4,279
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE & AD & D --VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $27,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,729
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameJAS. D. COLLIER & CO.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 2
Insurance contract or identification numberG000ABAR
Number of Individuals Covered232
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $2,086
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $12,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,086
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameJAS. D. COLLIER & CO.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 2
Insurance contract or identification numberG000ABAR
Number of Individuals Covered213
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $1,872
Total amount of fees paid to insurance companyUSD $1,872
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $11,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number126479
Policy instance 1
Insurance contract or identification number126479
Number of Individuals Covered132
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $26,718
Total amount of fees paid to insurance companyUSD $26,718
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $411,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ABAR
Policy instance 3
Insurance contract or identification numberG000ABAR
Number of Individuals Covered67
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $3,867
Total amount of fees paid to insurance companyUSD $3,867
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE & AD & D --VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $24,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH68997
Policy instance 2
Insurance contract or identification numberH68997
Number of Individuals Covered106
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $22,671
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $479,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29771
Policy instance 4
Insurance contract or identification number29771
Number of Individuals Covered123
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $983
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05328364
Policy instance 3
Insurance contract or identification numberTS05328364
Number of Individuals Covered301
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $5,181
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $66,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberAW968
Policy instance 1
Insurance contract or identification numberAW968
Number of Individuals Covered62
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $8,930
Total amount of fees paid to insurance companyUSD $201
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedA&S LTD, CANCER, SUPP. HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $59,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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