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FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 401k Plan overview

Plan NameFOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN
Plan identification number 501

FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

FOXWORTH-GALBRAITH LUMBER COMPANY & ASSOCIATED COMPANIES has sponsored the creation of one or more 401k plans.

Company Name:FOXWORTH-GALBRAITH LUMBER COMPANY & ASSOCIATED COMPANIES
Employer identification number (EIN):750278040
NAIC Classification:444190
NAIC Description:Other Building Material Dealers

Additional information about FOXWORTH-GALBRAITH LUMBER COMPANY & ASSOCIATED COMPANIES

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1927-02-21
Company Identification Number: 0000548106
Legal Registered Office Address: 2150 E LAKE COOK RD STE 1010

BUFFALO GROVE
United States of America (USA)
60089

More information about FOXWORTH-GALBRAITH LUMBER COMPANY & ASSOCIATED COMPANIES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01RICH PERKINS RICH PERKINS2018-10-15
5012016-01-01RICH PERKINS RICH PERKINS2017-10-13
5012015-01-01RICH PERKINS RICH PERKINS2016-10-14
5012014-01-01RICH PERKINS RICH PERKINS2015-10-15
5012013-01-01RICH PERKINS RICH PERKINS2014-10-13
5012012-01-01RICH PERKINS RICH PERKINS2013-10-15
5012011-01-01RICH PERKINS RICH PERKINS2012-10-15
5012009-01-01JENNIFER THEDFORD JENNIFER THEDFORD2010-10-15

Plan Statistics for FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN

401k plan membership statisitcs for FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN

Measure Date Value
2022: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01808
Total number of active participants reported on line 7a of the Form 55002022-01-01806
Number of retired or separated participants receiving benefits2022-01-0114
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01820
2021: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01755
Total number of active participants reported on line 7a of the Form 55002021-01-01796
Number of retired or separated participants receiving benefits2021-01-019
Number of other retired or separated participants entitled to future benefits2021-01-013
Total of all active and inactive participants2021-01-01808
2020: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01777
Total number of active participants reported on line 7a of the Form 55002020-01-01743
Number of retired or separated participants receiving benefits2020-01-0112
Number of other retired or separated participants entitled to future benefits2020-01-015
Total of all active and inactive participants2020-01-01760
2019: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01377
Total number of active participants reported on line 7a of the Form 55002019-01-01761
Number of retired or separated participants receiving benefits2019-01-0113
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01774
2018: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01357
Total number of active participants reported on line 7a of the Form 55002018-01-01377
Number of retired or separated participants receiving benefits2018-01-0117
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01394
2017: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01546
Total number of active participants reported on line 7a of the Form 55002017-01-01560
Number of retired or separated participants receiving benefits2017-01-0119
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01579
2016: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01496
Total number of active participants reported on line 7a of the Form 55002016-01-01546
Number of retired or separated participants receiving benefits2016-01-0120
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01566
2015: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01461
Total number of active participants reported on line 7a of the Form 55002015-01-01496
Number of retired or separated participants receiving benefits2015-01-0120
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01516
2014: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01402
Total number of active participants reported on line 7a of the Form 55002014-01-01461
Number of retired or separated participants receiving benefits2014-01-0124
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01485
2013: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01370
Total number of active participants reported on line 7a of the Form 55002013-01-01402
Number of retired or separated participants receiving benefits2013-01-0122
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01424
2012: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01350
Total number of active participants reported on line 7a of the Form 55002012-01-01370
Number of retired or separated participants receiving benefits2012-01-0126
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01396
2011: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01364
Total number of active participants reported on line 7a of the Form 55002011-01-01350
Number of retired or separated participants receiving benefits2011-01-0124
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01374
2009: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01894
Total number of active participants reported on line 7a of the Form 55002009-01-01460
Number of retired or separated participants receiving benefits2009-01-0157
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01517

Form 5500 Responses for FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN

2022: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: FOXWORTH-GALBRAITH LUMBER COMPANY HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS02483-21
Policy instance 5
Insurance contract or identification numberLGS02483-21
Number of Individuals Covered813
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $45,858
Other welfare benefits providedEXCESS LOSS
Welfare Benefit Premiums Paid to CarrierUSD $655,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees45858
Additional information about fees paid to insurance brokerADMIN FEE
Insurance broker organization code?5
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017888-00
Policy instance 4
Insurance contract or identification number01-017888-00
Number of Individuals Covered990
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $11,222
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $351,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11222
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 3
Insurance contract or identification number081509
Number of Individuals Covered1462
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $31,274
Total amount of fees paid to insurance companyUSD $6,504
Health Insurance Welfare BenefitYes
Dental 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 $31,274
Amount paid for insurance broker fees6504
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 2
Insurance contract or identification number99310231001
Number of Individuals Covered1438
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 1
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered1400
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $42,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 1
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered1160
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $28,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 2
Insurance contract or identification number99310231001
Number of Individuals Covered1500
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 3
Insurance contract or identification number081509
Number of Individuals Covered1517
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $28,944
Total amount of fees paid to insurance companyUSD $5,320
Health Insurance Welfare BenefitYes
Dental 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 $28,944
Amount paid for insurance broker fees5320
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017888-00
Policy instance 4
Insurance contract or identification number01-017888-00
Number of Individuals Covered1012
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $6,148
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $313,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6148
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS02483-21
Policy instance 5
Insurance contract or identification numberLGS02483-21
Number of Individuals Covered780
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of fees paid to insurance companyUSD $43,560
Other welfare benefits providedEXCESS LOSS
Welfare Benefit Premiums Paid to CarrierUSD $622,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees43560
Additional information about fees paid to insurance brokerADMIN FEE
Insurance broker organization code?5
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017888-00
Policy instance 4
Insurance contract or identification number01-017888-00
Number of Individuals Covered874
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $9,576
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $323,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees9576
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 3
Insurance contract or identification number081509
Number of Individuals Covered1504
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $29,494
Total amount of fees paid to insurance companyUSD $10,850
Health Insurance Welfare BenefitYes
Dental 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 $29,494
Amount paid for insurance broker fees10850
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 2
Insurance contract or identification number99310231001
Number of Individuals Covered1481
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 1
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered1160
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $19,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 1
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered950
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $19,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 2
Insurance contract or identification number99310231001
Number of Individuals Covered1596
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 3
Insurance contract or identification number081509
Number of Individuals Covered1498
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $8,184
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8184
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013280-000
Policy instance 4
Insurance contract or identification number16-013280-000
Number of Individuals Covered760
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $23,722
Welfare Benefit Premiums Paid to CarrierUSD $454,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees23722
Additional information about fees paid to insurance brokerGROUP MARKETING SUPPORT
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017888-00
Policy instance 5
Insurance contract or identification number01-017888-00
Number of Individuals Covered867
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $5,441
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $252,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5441
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 1
Insurance contract or identification number079228
Number of Individuals Covered868
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $239,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 2
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered800
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $19,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 3
Insurance contract or identification number99310231001
Number of Individuals Covered1822
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 4
Insurance contract or identification number081509
Number of Individuals Covered1452
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,708
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,708
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013280-000
Policy instance 5
Insurance contract or identification number16-013280-000
Number of Individuals Covered740
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of fees paid to insurance companyUSD $21,836
Welfare Benefit Premiums Paid to CarrierUSD $413,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees21836
Additional information about fees paid to insurance brokerGROUP MARKETING SUPPORT
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 7
Insurance contract or identification number07399
Number of Individuals Covered54
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 8
Insurance contract or identification number07399
Number of Individuals Covered76
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 9
Insurance contract or identification number07399
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 10
Insurance contract or identification number07399
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 11
Insurance contract or identification number07399
Number of Individuals Covered123
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 12
Insurance contract or identification number07399
Number of Individuals Covered123
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 13
Insurance contract or identification number07399
Number of Individuals Covered121
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013280-000
Policy instance 15
Insurance contract or identification number16-013280-000
Number of Individuals Covered569
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $13,841
Welfare Benefit Premiums Paid to CarrierUSD $276,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees13841
Additional information about fees paid to insurance brokerGROUP MARKETING SUPPORT
Insurance broker organization code?3
Insurance broker nameSTEALTH BENEFIT SOLUTIONS INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07399
Policy instance 6
Insurance contract or identification number07399
Number of Individuals Covered54
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,712
Total amount of fees paid to insurance companyUSD $28
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,712
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees28
Insurance broker nameAXA ASSISTANCE USA
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8200
Policy instance 5
Insurance contract or identification number8200
Number of Individuals Covered94
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,222
Total amount of fees paid to insurance companyUSD $2,012
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,222
Amount paid for insurance broker fees2012
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number99310231001
Policy instance 4
Insurance contract or identification number99310231001
Number of Individuals Covered1344
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number081509
Policy instance 14
Insurance contract or identification number081509
Number of Individuals Covered1233
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,873
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,873
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number156035
Policy instance 1
Insurance contract or identification number156035
Number of Individuals Covered124
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $26,240
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $527,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,240
Insurance broker organization code?3
Insurance broker nameHUBB INTERNATIONAL MIDWEST LIMITED
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered645
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,225
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $173,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,225
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 3
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered800
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $19,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1136
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $5,832
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5832
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered489
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered69
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENY LLC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL18145
Policy instance 4
Insurance contract or identification numberHCL18145
Number of Individuals Covered515
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $308,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 5
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered600
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Other welfare benefits providedOTHER (SPECIFY) EAP
Welfare Benefit Premiums Paid to CarrierUSD $16,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMHBT INC
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9934050
Policy instance 6
Insurance contract or identification number9934050
Number of Individuals Covered4
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9931023
Policy instance 7
Insurance contract or identification number9931023
Number of Individuals Covered1075
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1126
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered473
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered499
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY INC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL18145
Policy instance 4
Insurance contract or identification numberHCL18145
Number of Individuals Covered458
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $271,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 5
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered600
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Other welfare benefits providedOTHER (SPECIFY) EAP
Welfare Benefit Premiums Paid to CarrierUSD $15,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMHBT INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1053
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,796
Total amount of fees paid to insurance companyUSD $5,726
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,922
Amount paid for insurance broker fees5726
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered428
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered480
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 5
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered540
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Other welfare benefits providedOTHER (SPECIFY) EAP
Welfare Benefit Premiums Paid to CarrierUSD $13,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL18145
Policy instance 4
Insurance contract or identification numberHCL18145
Number of Individuals Covered410
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,643
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,296
Insurance broker organization code?3
Insurance broker nameMC & H LIFE AGENCY
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberFXGLO-001
Policy instance 5
Insurance contract or identification numberFXGLO-001
Number of Individuals Covered540
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Other welfare benefits providedOTHER (SPECIFY) EAP
Welfare Benefit Premiums Paid to CarrierUSD $13,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL18145
Policy instance 4
Insurance contract or identification numberHCL18145
Number of Individuals Covered374
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,312
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,312
Insurance broker organization code?3
Insurance broker nameTHE PLEXUS GROUPE
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered487
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered399
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1005
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,641
Total amount of fees paid to insurance companyUSD $5,950
Health Insurance Welfare BenefitYes
Dental 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 $6,641
Amount paid for insurance broker fees5950
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameTHE PLEXUS GROUP INC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL18145
Policy instance 4
Insurance contract or identification numberHCL18145
Number of Individuals Covered387
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,047
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered525
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1042
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $12,904
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered410
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 3
Insurance contract or identification number079228
Number of Individuals Covered559
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number079228
Policy instance 2
Insurance contract or identification number079228
Number of Individuals Covered397
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number81509
Policy instance 1
Insurance contract or identification number81509
Number of Individuals Covered1034
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $16,684
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,684
Insurance broker organization code?3
Insurance broker nameTHE PLEXUS GROUP INC

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