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JESSE STUTTS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameJESSE STUTTS, INC. WELFARE BENEFIT PLAN
Plan identification number 501

JESSE STUTTS, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Supplemental unemployment
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:JESSE STUTTS, INC.
Employer identification number (EIN):630723413
NAIC Classification:238210
NAIC Description:Electrical Contractors and Other Wiring Installation Contractors

Additional information about JESSE STUTTS, INC.

Jurisdiction of Incorporation: Alabama Secretary of State
Incorporation Date: 1977-03-16
Company Identification Number: 045-550
Legal Registered Office Address: 3414 9TH AVE SW HUNTSVILLE,


United States of America (USA)
35805

More information about JESSE STUTTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JESSE STUTTS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01
5012020-10-01
5012019-10-01
5012018-10-01
5012017-10-01JIMMY WALL JIMMY WALL2018-11-28
5012016-10-01JIMMY WALL JIMMY WALL2017-11-09
5012015-10-01JIMMY WALL JIMMY WALL2017-01-12
5012015-10-01JIMMY WALL JIMMY WALL2017-01-12
5012014-10-01JIMMY WALL JIMMY WALL2015-12-08
5012013-10-01JIMMY WALL JIMMY WALL2015-05-18
5012012-10-01JIMMY WALL JIMMY WALL2014-04-22
5012011-10-01JIMMY WALL JIMMY WALL2013-07-10
5012010-03-01JIMMY WALL

Plan Statistics for JESSE STUTTS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for JESSE STUTTS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2021: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01188
Total number of active participants reported on line 7a of the Form 55002021-10-01205
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01205
2020: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01224
Total number of active participants reported on line 7a of the Form 55002020-10-01188
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01188
2019: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01173
Total number of active participants reported on line 7a of the Form 55002019-10-01224
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01224
2018: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01147
Total number of active participants reported on line 7a of the Form 55002018-10-01173
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01173
2017: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01302
Total number of active participants reported on line 7a of the Form 55002017-10-01147
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01147
2016: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01344
Total number of active participants reported on line 7a of the Form 55002016-10-01302
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01302
2015: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01340
Total number of active participants reported on line 7a of the Form 55002015-10-01344
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01344
2014: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01351
Total number of active participants reported on line 7a of the Form 55002014-10-01340
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01340
2013: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01344
Total number of active participants reported on line 7a of the Form 55002013-10-01351
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01351
2012: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01283
Total number of active participants reported on line 7a of the Form 55002012-10-01344
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01344
2011: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01275
Total number of active participants reported on line 7a of the Form 55002011-10-01283
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01283
2010: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-01109
Total number of active participants reported on line 7a of the Form 55002010-03-01109
Total of all active and inactive participants2010-03-01109

Form 5500 Responses for JESSE STUTTS, INC. WELFARE BENEFIT PLAN

2021: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes
2018: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – InsuranceYes
2017: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – InsuranceYes
2016: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2010: JESSE STUTTS, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10002
Policy instance 9
Insurance contract or identification number1131917-10002
Number of Individuals Covered16
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $584
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $584
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10001
Policy instance 1
Insurance contract or identification number1131917-10001
Number of Individuals Covered319
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $15,905
Total amount of fees paid to insurance companyUSD $4,148
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,905
Amount paid for insurance broker fees4148
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered127
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $18,413
Total amount of fees paid to insurance companyUSD $142
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,400
Amount paid for insurance broker fees71
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered492
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberLXQ70
Policy instance 4
Insurance contract or identification numberLXQ70
Number of Individuals Covered5
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $1,098
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $437
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ68
Policy instance 5
Insurance contract or identification numberLXQ68
Number of Individuals Covered3
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $449
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $172
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberM2A58
Policy instance 6
Insurance contract or identification numberM2A58
Number of Individuals Covered5
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $737
Total amount of fees paid to insurance companyUSD $16
Welfare Benefit Premiums Paid to CarrierUSD $6,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $197
Amount paid for insurance broker fees8
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10003
Policy instance 7
Insurance contract or identification number1131917-10003
Number of Individuals Covered35
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $1,175
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,175
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10004
Policy instance 8
Insurance contract or identification number1131917-10004
Number of Individuals Covered18
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $1,078
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,078
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10001
Policy instance 1
Insurance contract or identification number1131917-10001
Number of Individuals Covered356
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $15,203
Total amount of fees paid to insurance companyUSD $3,867
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $124,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,203
Amount paid for insurance broker fees3867
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered151
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $24,670
Total amount of fees paid to insurance companyUSD $176
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,022
Amount paid for insurance broker fees36
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered521
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberLXQ70
Policy instance 4
Insurance contract or identification numberLXQ70
Number of Individuals Covered5
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $646
Total amount of fees paid to insurance companyUSD $40
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $166
Amount paid for insurance broker fees24
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ68
Policy instance 5
Insurance contract or identification numberLXQ68
Number of Individuals Covered3
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $486
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $187
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberM2A58
Policy instance 6
Insurance contract or identification numberM2A58
Number of Individuals Covered8
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $2,286
Total amount of fees paid to insurance companyUSD $91
Welfare Benefit Premiums Paid to CarrierUSD $12,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $383
Amount paid for insurance broker fees18
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10003
Policy instance 7
Insurance contract or identification number1131917-10003
Number of Individuals Covered34
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $1,154
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,154
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10004
Policy instance 8
Insurance contract or identification number1131917-10004
Number of Individuals Covered28
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $1,399
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,399
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10002
Policy instance 9
Insurance contract or identification number1131917-10002
Number of Individuals Covered24
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $562
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $562
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10001
Policy instance 1
Insurance contract or identification number1131917-10001
Number of Individuals Covered340
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $13,768
Total amount of fees paid to insurance companyUSD $4,518
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,902
Amount paid for insurance broker fees4518
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered145
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $18,854
Total amount of fees paid to insurance companyUSD $526
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,881
Amount paid for insurance broker fees306
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ70
Policy instance 4
Insurance contract or identification numberLXQ70
Number of Individuals Covered6
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,044
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $357
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered513
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberLXQ68
Policy instance 5
Insurance contract or identification numberLXQ68
Number of Individuals Covered3
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $409
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $158
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberM2A58
Policy instance 6
Insurance contract or identification numberM2A58
Number of Individuals Covered12
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $2,809
Total amount of fees paid to insurance companyUSD $149
Welfare Benefit Premiums Paid to CarrierUSD $10,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,142
Amount paid for insurance broker fees64
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10003
Policy instance 7
Insurance contract or identification number1131917-10003
Number of Individuals Covered34
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,142
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $684
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10004
Policy instance 8
Insurance contract or identification number1131917-10004
Number of Individuals Covered31
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,529
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $767
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1131917-10002
Policy instance 9
Insurance contract or identification number1131917-10002
Number of Individuals Covered19
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $621
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $376
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberM2A58
Policy instance 6
Insurance contract or identification numberM2A58
Number of Individuals Covered11
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $401
Total amount of fees paid to insurance companyUSD $31
Welfare Benefit Premiums Paid to CarrierUSD $1,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $161
Amount paid for insurance broker fees17
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ68
Policy instance 5
Insurance contract or identification numberLXQ68
Number of Individuals Covered3
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $323
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $129
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ70
Policy instance 4
Insurance contract or identification numberLXQ70
Number of Individuals Covered4
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $209
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered538
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered138
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $24,593
Total amount of fees paid to insurance companyUSD $420
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,073
Amount paid for insurance broker fees237
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered412
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $16,119
Total amount of fees paid to insurance companyUSD $2,904
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,119
Amount paid for insurance broker fees2904
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered112
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $16,911
Total amount of fees paid to insurance companyUSD $585
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,282
Amount paid for insurance broker fees327
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered308
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $12,440
Total amount of fees paid to insurance companyUSD $2,425
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,440
Amount paid for insurance broker fees2425
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered388
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberLXQ70
Policy instance 4
Insurance contract or identification numberLXQ70
Number of Individuals Covered4
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $498
Total amount of fees paid to insurance companyUSD $10
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $171
Amount paid for insurance broker fees6
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberLXQ68
Policy instance 5
Insurance contract or identification numberLXQ68
Number of Individuals Covered4
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $391
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $148
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered328
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedAIR MED SERVICES, BABY YOURSELF
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 numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered108
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $14,349
Total amount of fees paid to insurance companyUSD $163
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,143
Amount paid for insurance broker fees91
Insurance broker nameSUWAT ASSAWAMATIYANONT
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered259
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $10,687
Total amount of fees paid to insurance companyUSD $1,370
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,687
Amount paid for insurance broker fees1370
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN JR
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered86
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $12,875
Total amount of fees paid to insurance companyUSD $32
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $780
Amount paid for insurance broker fees16
Insurance broker nameSCOTT J. RUSSELL
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered243
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $9,430
Total amount of fees paid to insurance companyUSD $2,223
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,430
Amount paid for insurance broker fees2223
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN JR
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered344
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEPS
Welfare Benefit Premiums Paid to CarrierUSD $13,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered340
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF, EPS, AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $15,851
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 numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered257
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $10,241
Total amount of fees paid to insurance companyUSD $2,268
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,241
Amount paid for insurance broker fees2268
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN JR
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered85
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $8,139
Total amount of fees paid to insurance companyUSD $72
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,314
Amount paid for insurance broker fees24
Insurance broker nameRONALD KIRKLAND
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered84
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $16,765
Total amount of fees paid to insurance companyUSD $235
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,107
Amount paid for insurance broker fees80
Insurance broker nameJASON L. WEEKS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered283
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $10,352
Total amount of fees paid to insurance companyUSD $2,072
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,352
Amount paid for insurance broker fees2072
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN JR
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered351
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF, EPS, AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $17,760
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 numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered272
Insurance policy start date2013-03-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $5,049
Total amount of fees paid to insurance companyUSD $1,660
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,049
Amount paid for insurance broker fees1660
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN JR
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered112
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $12,491
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,522
Insurance broker nameSCOTT J. RUSSELL
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered344
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF, EPS, AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $13,784
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 numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered251
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $7,505
Total amount of fees paid to insurance companyUSD $1,353
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,627
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 numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered83
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $7,974
Total amount of fees paid to insurance companyUSD $144
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered283
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF EPS AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $11,432
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 numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered216
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $6,973
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered275
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF, EPS, AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $13,190
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 numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered75
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $27,422
Total amount of fees paid to insurance companyUSD $1,193
Temporary Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
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 numberH67565
Policy instance 1
Insurance contract or identification numberH67565
Number of Individuals Covered109
Insurance policy start date2010-03-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $4,368
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 $4,368
Insurance broker organization code?3
Insurance broker nameBARRY GANN BRYAN
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberC3Z41
Policy instance 2
Insurance contract or identification numberC3Z41
Number of Individuals Covered109
Insurance policy start date2010-03-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $19,123
Total amount of fees paid to insurance companyUSD $1
Temporary Disability Insurance Welfare BenefitYes
Unemployment 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 $12,514
Amount paid for insurance broker fees1
Insurance broker nameSAIC INC
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number34284
Policy instance 3
Insurance contract or identification number34284
Number of Individuals Covered109
Insurance policy start date2010-03-01
Insurance policy end date2010-09-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedBABY YOURSELF EPS AIRMED
Welfare Benefit Premiums Paid to CarrierUSD $11,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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