HAYNES AMBULANCE OF ALABAMA, INC. has sponsored the creation of one or more 401k plans.
Additional information about HAYNES AMBULANCE OF ALABAMA, INC.
Submission information for form 5500 for 401k plan HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN
401k plan membership statisitcs for HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2020: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 218 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 236 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 34 |
| Total of all active and inactive participants | 2020-01-01 | 270 |
| 2019: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 176 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 42 |
| Total of all active and inactive participants | 2019-01-01 | 218 |
| 2018: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 203 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 50 |
| Total of all active and inactive participants | 2018-01-01 | 253 |
| 2017: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 198 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 14 |
| Total of all active and inactive participants | 2017-10-01 | 212 |
| 2016: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 198 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 14 |
| Total of all active and inactive participants | 2016-10-01 | 212 |
| 2015: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 147 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 45 |
| Total of all active and inactive participants | 2015-10-01 | 192 |
| 2014: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 150 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 31 |
| Total of all active and inactive participants | 2014-10-01 | 181 |
| 2013: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 182 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 131 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 37 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
| Total of all active and inactive participants | 2013-10-01 | 168 |
| 2012: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 182 |
| Total of all active and inactive participants | 2012-10-01 | 182 |
| 2011: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 181 |
| Total of all active and inactive participants | 2011-10-01 | 181 |
| 2010: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 158 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 0 |
| Total of all active and inactive participants | 2010-10-01 | 158 |
| 2020: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: HAYNES AMBULANCE OF ALABAMA, INC. RESTATED CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | Submission has been amended | No |
| 2010-10-01 | This submission is the final filing | No |
| 2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-10-01 | Plan is a collectively bargained plan | No |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 2 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $14,456 | | Total amount of fees paid to insurance company | USD $336 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $75,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,279 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 153 | | Additional information about fees paid to insurance broker | FEES PAID |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5954768 |
| Policy instance | 1 |
| Insurance contract or identification number | 5954768 | | Number of Individuals Covered | 690 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $45,580 | | Total amount of fees paid to insurance company | USD $6,100 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $257,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,517 | | Amount paid for insurance broker fees | 2423 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5954768 |
| Policy instance | 1 |
| Insurance contract or identification number | 5954768 | | Number of Individuals Covered | 463 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $111,042 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,374 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2021 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00546238 |
| Policy instance | 2 |
| Insurance contract or identification number | 00546238 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $12,671 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,423 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | A8V93 |
| Policy instance | 3 |
| Insurance contract or identification number | A8V93 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $12,307 | | Total amount of fees paid to insurance company | USD $893 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $71,026 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,528 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 246 | | Additional information about fees paid to insurance broker | FEES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30040285 |
| Policy instance | 1 |
| Insurance contract or identification number | 30040285 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $1,625 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,625 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00546238 |
| Policy instance | 2 |
| Insurance contract or identification number | 00546238 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,332 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,332 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | A8V93 |
| Policy instance | 3 |
| Insurance contract or identification number | A8V93 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $18,402 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,781 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 85597 |
| Policy instance | 1 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30040285 |
| Policy instance | 2 |
| Insurance contract or identification number | 30040285 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $1,625 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VIVA HEALTH (National Association of Insurance Commissioners NAIC id number: 95322 ) |
| Policy contract number | HAY001 |
| Policy instance | 3 |
| Insurance contract or identification number | HAY001 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $766,087 | | 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 number | A8V93 |
| Policy instance | 4 |
| Insurance contract or identification number | A8V93 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,288 | | Total amount of fees paid to insurance company | USD $211 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $60,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VIVA HEALTH (National Association of Insurance Commissioners NAIC id number: 95322 ) |
| Policy contract number | HAY001 |
| Policy instance | 1 |
| Insurance contract or identification number | HAY001 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $644,825 | | 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 number | A8V93 |
| Policy instance | 3 |
| Insurance contract or identification number | A8V93 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $11,417 | | Total amount of fees paid to insurance company | USD $223 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $60,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,339 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | FEES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30040285 |
| Policy instance | 4 |
| Insurance contract or identification number | 30040285 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,959 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,959 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 85597 |
| Policy instance | 5 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871199G |
| Policy instance | 2 |
| Insurance contract or identification number | 871199G | | Number of Individuals Covered | 232 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $12,406 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, VOLUNTARY LIFE, WD-NST | | Welfare Benefit Premiums Paid to Carrier | USD $82,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,406 | | Insurance broker organization code? | 3 |
|
| VIVA HEALTH (National Association of Insurance Commissioners NAIC id number: 95322 ) |
| Policy contract number | HAY001 |
| Policy instance | 1 |
| Insurance contract or identification number | HAY001 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $419,476 | | 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 number | A8V93 |
| Policy instance | 3 |
| Insurance contract or identification number | A8V93 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $17,015 | | Total amount of fees paid to insurance company | USD $863 | | Other welfare benefits provided | SUPPLEMENTAL HOSPITAL, ACCIDENT, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $63,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,186 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 119 | | Additional information about fees paid to insurance broker | FEES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30040285 |
| Policy instance | 4 |
| Insurance contract or identification number | 30040285 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,827 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 85597 |
| Policy instance | 2 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30040285 |
| Policy instance | 1 |
| Insurance contract or identification number | 30040285 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,623 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) |
| Policy contract number | 85597 |
| Policy instance | 2 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS | | 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 number | 85597 |
| Policy instance | 1 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS | | 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 number | 85597 |
| Policy instance | 1 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS | | 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 number | 85597 |
| Policy instance | 1 |
| Insurance contract or identification number | 85597 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
