DUPLANTIER, HRAPMANN, HOGAN & MAHER, LLP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 501 | 2016-01-01 | LINDSAY J. CALUB, CPA, PARTNER | | LINDSAY J. CALUB, CPA, PARTNER | 2017-06-15 |
| 501 | 2015-01-01 | LINDSAY J. CALUB, CPA, PARTNER | | LINDSAY J. CALUB, CPA, PARTNER | 2016-08-31 |
| 501 | 2014-01-01 | WILLIAM G. STAMM, CPA, PARTNER | | WILLIAM G. STAMM, CPA, PARTNER | 2015-07-20 |
| 501 | 2013-01-01 | WILLIAM G. STAMM, CPA, PARTNER | | WILLIAM G. STAMM, CPA, PARTNER | 2014-10-13 |
| 501 | 2012-01-01 | WILLIAM G. STAMM, CPA, PARTNER | | WILLIAM G. STAMM, CPA, PARTNER | 2013-10-09 |
| 501 | 2011-01-01 | WILLIAM G. STAMM, CPA, PARTNER | | WILLIAM G. STAMM, CPA, PARTNER | 2012-12-11 |
| 501 | 2010-01-01 | WILLIAM G. STAMM, CPA, PARTNER | | WILLIAM G. STAMM, CPA, PARTNER | 2011-09-26 |
| 501 | 2009-01-01 | MICHAEL J. O'ROURKE, CPA, PARTNER | | MICHAEL J. O'ROURKE, CPA, PARTNER | 2010-09-20 |
401k plan membership statisitcs for DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2016: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 49 |
| Total of all active and inactive participants | 2016-01-01 | 49 |
| 2015: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 45 |
| Total of all active and inactive participants | 2015-01-01 | 45 |
| 2014: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 42 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 45 |
| Total of all active and inactive participants | 2014-01-01 | 45 |
| 2013: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 42 |
| Total of all active and inactive participants | 2013-01-01 | 42 |
| 2012: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 44 |
| Total of all active and inactive participants | 2012-01-01 | 44 |
| 2011: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 50 |
| Total of all active and inactive participants | 2011-01-01 | 50 |
| 2010: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 50 |
| Total of all active and inactive participants | 2010-01-01 | 50 |
| 2009: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 51 |
| Total of all active and inactive participants | 2009-01-01 | 51 |
| Measure | Date | Value |
|---|
| 2016 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $455,667 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $454,905 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $454,905 |
| Total plan assets at end of year | 2016-12-31 | $8,659 |
| Total plan assets at beginning of year | 2016-12-31 | $7,897 |
| Total contributions received or receivable from participants | 2016-12-31 | $180,365 |
| Net income (gross income less expenses) | 2016-12-31 | $762 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $8,659 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $7,897 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $275,302 |
| 2015 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $377,724 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $376,149 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $376,149 |
| Total plan assets at end of year | 2015-12-31 | $7,897 |
| Total plan assets at beginning of year | 2015-12-31 | $6,322 |
| Total contributions received or receivable from participants | 2015-12-31 | $141,909 |
| Net income (gross income less expenses) | 2015-12-31 | $1,575 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $7,897 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $6,322 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $235,815 |
| 2014 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $336,308 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $336,041 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $336,041 |
| Total plan assets at end of year | 2014-12-31 | $6,322 |
| Total plan assets at beginning of year | 2014-12-31 | $6,055 |
| Total contributions received or receivable from participants | 2014-12-31 | $138,223 |
| Net income (gross income less expenses) | 2014-12-31 | $267 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $6,322 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $6,055 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $198,085 |
| 2013 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $273,293 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $273,461 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $273,461 |
| Total plan assets at end of year | 2013-12-31 | $6,055 |
| Total plan assets at beginning of year | 2013-12-31 | $6,223 |
| Total contributions received or receivable from participants | 2013-12-31 | $114,198 |
| Net income (gross income less expenses) | 2013-12-31 | $-168 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $6,055 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $6,223 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $159,095 |
| 2012 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $288,247 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $286,876 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $286,876 |
| Total plan assets at end of year | 2012-12-31 | $6,223 |
| Total plan assets at beginning of year | 2012-12-31 | $4,852 |
| Total contributions received or receivable from participants | 2012-12-31 | $107,709 |
| Net income (gross income less expenses) | 2012-12-31 | $1,371 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $6,223 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $4,852 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $180,538 |
| 2011 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $262,410 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $265,092 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $265,092 |
| Total plan assets at end of year | 2011-12-31 | $4,852 |
| Total plan assets at beginning of year | 2011-12-31 | $7,534 |
| Total contributions received or receivable from participants | 2011-12-31 | $93,714 |
| Net income (gross income less expenses) | 2011-12-31 | $-2,682 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $4,852 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $7,534 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $168,696 |
| 2010 : DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $275,493 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $273,575 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $273,575 |
| Total plan assets at end of year | 2010-12-31 | $7,534 |
| Total plan assets at beginning of year | 2010-12-31 | $5,616 |
| Total contributions received or receivable from participants | 2010-12-31 | $96,016 |
| Net income (gross income less expenses) | 2010-12-31 | $1,918 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $7,534 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $5,616 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $179,477 |
| 2016: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: DUPLANTIER, HRAPMANN, HOGAN AND MAHER CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,228 | | Total amount of fees paid to insurance company | USD $207 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $8,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $464 | | Amount paid for insurance broker fees | 149 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MULLEN |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05501 |
| Policy instance | 3 |
| Insurance contract or identification number | 05501 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,321 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,321 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 ) |
| Policy contract number | 639974 |
| Policy instance | 2 |
| Insurance contract or identification number | 639974 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $18,795 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $339,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,795 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC. |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 ) |
| Policy contract number | 639974 |
| Policy instance | 2 |
| Insurance contract or identification number | 639974 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $14,390 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $309,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,390 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,313 | | Total amount of fees paid to insurance company | USD $286 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $9,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $712 | | Amount paid for insurance broker fees | 107 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MULLEN |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05501 |
| Policy instance | 3 |
| Insurance contract or identification number | 05501 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,450 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,450 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05501 |
| Policy instance | 3 |
| Insurance contract or identification number | 05501 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,147 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,147 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $889 | | Total amount of fees paid to insurance company | USD $175 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $8,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $353 | | Amount paid for insurance broker fees | 134 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MULLEN |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | 77088FF2 |
| Policy instance | 2 |
| Insurance contract or identification number | 77088FF2 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-02-01 | | Total amount of commissions paid to insurance broker | USD $10,042 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,042 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN H. THOMAS, BEST GROUP, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $806 | | Total amount of fees paid to insurance company | USD $86 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $8,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $319 | | Amount paid for insurance broker fees | 29 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MULLEN |
|
| BROKERS NATIONAL LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 74900 ) |
| Policy contract number | 82520 |
| Policy instance | 5 |
| Insurance contract or identification number | 82520 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | BEST GROUP, INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05501 |
| Policy instance | 3 |
| Insurance contract or identification number | 05501 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $933 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $933 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | 77088FF2 |
| Policy instance | 2 |
| Insurance contract or identification number | 77088FF2 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-02-01 | | Total amount of commissions paid to insurance broker | USD $12,015 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,015 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN H. THOMAS, BEST GROUP, INC. |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 05501 |
| Policy instance | 3 |
| Insurance contract or identification number | 05501 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $437 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | 77088FF2 |
| Policy instance | 2 |
| Insurance contract or identification number | 77088FF2 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-02-01 | | Total amount of commissions paid to insurance broker | USD $11,364 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $230,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $511 | | Total amount of fees paid to insurance company | USD $47 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $8,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BROKERS NATIONAL LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 74900 ) |
| Policy contract number | 82520 |
| Policy instance | 5 |
| Insurance contract or identification number | 82520 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $319 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | 77088FF2 |
| Policy instance | 2 |
| Insurance contract or identification number | 77088FF2 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2009-02-01 | | Insurance policy end date | 2010-02-01 | | Total amount of commissions paid to insurance broker | USD $12,254 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $245,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,254 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN H. THOMAS, BEST GROUP, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E9869652 |
| Policy instance | 1 |
| Insurance contract or identification number | E9869652 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,700 | | Total amount of fees paid to insurance company | USD $2,902 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $11,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,776 | | Amount paid for insurance broker fees | 2028 | | Insurance broker organization code? | 3 | | Insurance broker name | STEVEN MULLEN |
|
| BROKERS NATIONAL LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 74900 ) |
| Policy contract number | 82520 |
| Policy instance | 3 |
| Insurance contract or identification number | 82520 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $864 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $864 | | Insurance broker organization code? | 3 | | Insurance broker name | BEST GROUP, INC |
|
