UNITED SUPERMARKETS, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 8,109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 7,570 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 53 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 7,623 |
| 2021: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 8,243 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 8,017 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 92 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 8,109 |
| 2020: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 8,318 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 8,199 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 8,243 |
| 2019: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 8,984 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 8,263 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 55 |
| Total of all active and inactive participants | 2019-01-01 | 8,318 |
| Total participants | 2019-01-01 | 8,318 |
| 2018: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 7,895 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 8,928 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 56 |
| Total of all active and inactive participants | 2018-01-01 | 8,984 |
| Total participants | 2018-01-01 | 8,984 |
| 2017: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 4,382 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 7,895 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 58 |
| Total of all active and inactive participants | 2017-01-01 | 7,953 |
| Total participants | 2017-01-01 | 7,953 |
| 2016: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 2,935 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 4,382 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 63 |
| Total of all active and inactive participants | 2016-01-01 | 4,445 |
| Total participants | 2016-01-01 | 4,445 |
| 2015: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 2,696 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 2,935 |
| Total of all active and inactive participants | 2015-01-01 | 2,935 |
| Total participants | 2015-01-01 | 0 |
| 2014: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 3,005 |
| Total of all active and inactive participants | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 0 |
| 2013: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 2,751 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 2,696 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 309 |
| Total of all active and inactive participants | 2013-01-01 | 3,005 |
| Total participants | 2013-01-01 | 0 |
| 2012: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 3,089 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 2,694 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 57 |
| Total of all active and inactive participants | 2012-01-01 | 2,751 |
| Total participants | 2012-01-01 | 0 |
| 2011: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 2,957 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 3,021 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 68 |
| Total of all active and inactive participants | 2011-01-01 | 3,089 |
| Total participants | 2011-01-01 | 3,089 |
| 2010: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 2,925 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 2,890 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 67 |
| Total of all active and inactive participants | 2010-01-01 | 2,957 |
| Total participants | 2010-01-01 | 2,957 |
| 2009: UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 2,513 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 2,856 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 69 |
| Total of all active and inactive participants | 2009-01-01 | 2,925 |
| Total participants | 2009-01-01 | 2,925 |
| Measure | Date | Value |
|---|
| 2015 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total of all expenses incurred | 2015-12-31 | $286,624 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $286,624 |
| Value of total assets at end of year | 2015-12-31 | $0 |
| Value of total assets at beginning of year | 2015-12-31 | $286,624 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $286,624 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-286,624 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $286,624 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2015-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $286,624 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | ROBINSON BURDETTE MARTIN SERIGHT |
| Accountancy firm EIN | 2015-12-31 | 752489868 |
| 2014 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2014 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $163,198 |
| Total income from all sources (including contributions) | 2014-12-31 | $26,957,188 |
| Total of all expenses incurred | 2014-12-31 | $29,582,365 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $26,260,392 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $26,956,784 |
| Value of total assets at end of year | 2014-12-31 | $286,624 |
| Value of total assets at beginning of year | 2014-12-31 | $3,074,999 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $3,321,973 |
| Total interest from all sources | 2014-12-31 | $404 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2014-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $10,223,438 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $163,198 |
| Total non interest bearing cash at end of year | 2014-12-31 | $286,624 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $286,027 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-2,625,177 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $286,624 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $2,911,801 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $2,788,972 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $2,788,972 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $404 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $1,850,243 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $16,733,346 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $24,410,149 |
| Contract administrator fees | 2014-12-31 | $3,321,973 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | ROBINSON,BURDETTE,MARTIN,SERIGHT |
| Accountancy firm EIN | 2014-12-31 | 752489868 |
| 2013 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $163,198 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $94,386 |
| Total income from all sources (including contributions) | 2013-12-31 | $28,988,532 |
| Total of all expenses incurred | 2013-12-31 | $28,770,525 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $26,110,704 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $28,987,815 |
| Value of total assets at end of year | 2013-12-31 | $3,074,999 |
| Value of total assets at beginning of year | 2013-12-31 | $2,788,180 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $2,659,821 |
| Total interest from all sources | 2013-12-31 | $717 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $11,018,343 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $163,198 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $94,386 |
| Total non interest bearing cash at end of year | 2013-12-31 | $286,027 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $206,983 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $218,007 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $2,911,801 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $2,693,794 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2013-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $2,788,972 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $2,581,197 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $2,581,197 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $717 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $1,819,488 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $17,969,472 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $24,291,216 |
| Contract administrator fees | 2013-12-31 | $2,659,821 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | ROBINSON,BURDETTE,MARTIN,SERIGHT |
| Accountancy firm EIN | 2013-12-31 | 752489868 |
| 2012 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $94,386 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $59,789 |
| Total income from all sources (including contributions) | 2012-12-31 | $26,776,640 |
| Total of all expenses incurred | 2012-12-31 | $25,762,728 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $24,070,264 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $26,776,156 |
| Value of total assets at end of year | 2012-12-31 | $2,788,180 |
| Value of total assets at beginning of year | 2012-12-31 | $1,739,671 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,692,464 |
| Total interest from all sources | 2012-12-31 | $484 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $8,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $10,482,514 |
| Participant contributions at beginning of year | 2012-12-31 | $148,856 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $94,386 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $59,789 |
| Total non interest bearing cash at end of year | 2012-12-31 | $206,983 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $149,533 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $1,013,912 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $2,693,794 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $1,679,882 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2012-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $2,581,197 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $1,126,546 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $1,126,546 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $484 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $2,262,563 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $16,293,642 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $314,736 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $21,807,701 |
| Contract administrator fees | 2012-12-31 | $1,692,464 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | ROBINSON,BURDETTE,MARTIN,SERIGHT |
| Accountancy firm EIN | 2012-12-31 | 752489868 |
| 2011 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $59,789 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $101,795 |
| Total income from all sources (including contributions) | 2011-12-31 | $26,056,417 |
| Total of all expenses incurred | 2011-12-31 | $26,596,393 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $24,291,154 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $26,056,241 |
| Value of total assets at end of year | 2011-12-31 | $1,739,671 |
| Value of total assets at beginning of year | 2011-12-31 | $2,321,653 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $2,305,239 |
| Total interest from all sources | 2011-12-31 | $176 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $8,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $9,442,319 |
| Participant contributions at end of year | 2011-12-31 | $148,856 |
| Participant contributions at beginning of year | 2011-12-31 | $279,427 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $59,789 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $101,795 |
| Total non interest bearing cash at end of year | 2011-12-31 | $149,533 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $205,313 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-539,976 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $1,679,882 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,219,858 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $1,126,546 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $1,317,976 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $1,317,976 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $176 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $1,833,256 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $16,613,922 |
| Employer contributions (assets) at end of year | 2011-12-31 | $314,736 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $518,937 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $22,457,898 |
| Contract administrator fees | 2011-12-31 | $2,305,239 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | ROBINSON,BURDETTE,MARTIN,SERIGHT |
| Accountancy firm EIN | 2011-12-31 | 752489868 |
| 2010 : UNITED SUPERMARKETS, LLC EMPLOYEE BENEFIT PLAN 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $101,795 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $61,561 |
| Total income from all sources (including contributions) | 2010-12-31 | $23,395,086 |
| Total of all expenses incurred | 2010-12-31 | $24,220,609 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $21,948,954 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $23,394,521 |
| Value of total assets at end of year | 2010-12-31 | $2,321,653 |
| Value of total assets at beginning of year | 2010-12-31 | $3,106,942 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $2,271,655 |
| Total interest from all sources | 2010-12-31 | $565 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $8,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $8,445,194 |
| Participant contributions at end of year | 2010-12-31 | $279,427 |
| Participant contributions at beginning of year | 2010-12-31 | $254,348 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $101,795 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $61,561 |
| Total non interest bearing cash at end of year | 2010-12-31 | $205,313 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $189,466 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-825,523 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $2,219,858 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $3,045,381 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $1,317,976 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $2,027,596 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $2,027,596 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $565 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $1,705,278 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $14,949,327 |
| Employer contributions (assets) at end of year | 2010-12-31 | $518,937 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $635,532 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $20,243,676 |
| Contract administrator fees | 2010-12-31 | $2,271,655 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | ROBINSON,BURDETTE,MARTIN,SERIGHT |
| Accountancy firm EIN | 2010-12-31 | 752489868 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 12282209 |
| Policy instance | 4 |
| Insurance contract or identification number | 12282209 | | Number of Individuals Covered | 4383 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,629 | | Total amount of fees paid to insurance company | USD $91,807 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $612,049 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,629 | | Amount paid for insurance broker fees | 91807 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS09152 |
| Policy instance | 3 |
| Insurance contract or identification number | ADDS09152 | | Number of Individuals Covered | 4700 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,133 | | Total amount of fees paid to insurance company | USD $1,899 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $105,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,133 | | Amount paid for insurance broker fees | 1899 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681852G |
| Policy instance | 2 |
| Insurance contract or identification number | 681852G | | Number of Individuals Covered | 8071 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $69,184 | | Total amount of fees paid to insurance company | USD $40,354 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,845,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,184 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 40354 | | Additional information about fees paid to insurance broker | BONUS PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 1 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1783 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of commissions paid to insurance broker | USD $111,579 | | Total amount of fees paid to insurance company | USD $8,381 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $366,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111,579 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 8381 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 1 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1263 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $33,175 | | Total amount of fees paid to insurance company | USD $2,229 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $228,931 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,175 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2229 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0002373456 |
| Policy instance | 2 |
| Insurance contract or identification number | 0002373456 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of commissions paid to insurance broker | USD $36 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36 | | Insurance broker organization code? | 3 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000023532 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000023532 | | Number of Individuals Covered | 2213 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $92,448 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $506,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,490 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681852G |
| Policy instance | 4 |
| Insurance contract or identification number | 681852G | | Number of Individuals Covered | 7571 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $42,191 | | Total amount of fees paid to insurance company | USD $10,496 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $938,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,191 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10496 | | Additional information about fees paid to insurance broker | BONUS PAID |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1758 |
| Policy instance | 5 |
| Insurance contract or identification number | G1758 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $2,240 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,240 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS09152 |
| Policy instance | 6 |
| Insurance contract or identification number | ADDS09152 | | Number of Individuals Covered | 4700 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $2,462 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $61,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,462 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 1 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 7283 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $53,534 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,480 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 12282209 |
| Policy instance | 2 |
| Insurance contract or identification number | 12282209 | | Number of Individuals Covered | 4293 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $20,707 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $721,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,707 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 3 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 7283 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $28,524 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,387 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 4 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1235 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $30,744 | | Total amount of fees paid to insurance company | USD $1,838 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $224,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,744 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1838 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 1 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 2141 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $45,592 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,709 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 12282209 |
| Policy instance | 2 |
| Insurance contract or identification number | 12282209 | | Number of Individuals Covered | 4099 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $14,925 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $656,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,925 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 4 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1311 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $36,382 | | Total amount of fees paid to insurance company | USD $2,162 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $314,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,382 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2162 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 3 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 6699 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $83,059 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,795 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 120119 |
| Policy instance | 1 |
| Insurance contract or identification number | LTD 120119 | | Number of Individuals Covered | 2021 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-06-01 | | Total amount of commissions paid to insurance broker | USD $84,482 | | Total amount of fees paid to insurance company | USD $11,225 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $563,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $84,482 | | Amount paid for insurance broker fees | 11225 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 12282209 |
| Policy instance | 2 |
| Insurance contract or identification number | 12282209 | | Number of Individuals Covered | 3939 | | Total amount of commissions paid to insurance broker | USD $80,604 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $626,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $80,604 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 3 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 6616 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $65,301 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,194 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 4 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1446 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $38,701 | | Total amount of fees paid to insurance company | USD $2,540 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,701 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2540 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0020164 |
| Policy instance | 4 |
| Insurance contract or identification number | R0020164 | | Number of Individuals Covered | 1681 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $57,301 | | Total amount of fees paid to insurance company | USD $3,996 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $347,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,301 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3996 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 753780 |
| Policy instance | 3 |
| Insurance contract or identification number | 753780 | | Number of Individuals Covered | 6376 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $44,913 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,000 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 010-350712 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-350712 | | Number of Individuals Covered | 7081 | | Total amount of commissions paid to insurance broker | USD $40,575 | | Total amount of fees paid to insurance company | USD $7,090 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $405,751 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,575 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7090 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 120119 |
| Policy instance | 1 |
| Insurance contract or identification number | LTD 120119 | | Number of Individuals Covered | 4357 | | Total amount of commissions paid to insurance broker | USD $74,834 | | Total amount of fees paid to insurance company | USD $9,076 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $498,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74,834 | | Amount paid for insurance broker fees | 9076 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 3 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $67,354 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $384,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,354 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350712 |
| Policy instance | 4 |
| Insurance contract or identification number | 010-350712 | | Number of Individuals Covered | 7209 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $60,350 | | Total amount of fees paid to insurance company | USD $3,518 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $603,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,350 | | Amount paid for insurance broker fees | 3518 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 19922 |
| Policy instance | 1 |
| Insurance contract or identification number | 19922 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0002373456 |
| Policy instance | 2 |
| Insurance contract or identification number | 0002373456 | | Number of Individuals Covered | 1114 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $16,001 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,073 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIS ALLEN AGENCY INC |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 404W92 |
| Policy instance | 4 |
| Insurance contract or identification number | 404W92 | | Number of Individuals Covered | 615 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $12,855 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,855 | | Insurance broker organization code? | 3 | | Insurance broker name | TOTAL BENEFIT SOLUTION |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 232904 |
| Policy instance | 3 |
| Insurance contract or identification number | 232904 | | Number of Individuals Covered | 3154 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $43,900 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $754,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,077 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350712 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-350712 | | Number of Individuals Covered | 5396 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $39,557 | | Total amount of fees paid to insurance company | USD $1,030 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $395,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,842 | | Amount paid for insurance broker fees | 1030 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC. |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 19922 |
| Policy instance | 1 |
| Insurance contract or identification number | 19922 | | Number of Individuals Covered | 5741 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $56,379 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,408 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFITS SERVICES, INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0002373456 |
| Policy instance | 5 |
| Insurance contract or identification number | 0002373456 | | Number of Individuals Covered | 1421 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $77,338 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $268,013 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,033 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLEN, CANNON, EDWARD C/O TOTAL BEN |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F019109 |
| Policy instance | 4 |
| Insurance contract or identification number | F019109 | | Number of Individuals Covered | 2265 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $122,821 | | Total amount of fees paid to insurance company | USD $676 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $818,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $122,821 | | Amount paid for insurance broker fees | 676 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 1 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 3264 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $49,493 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $329,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,493 | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 19922 |
| Policy instance | 2 |
| Insurance contract or identification number | 19922 | | Number of Individuals Covered | 5570 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $172,838 | | Total amount of fees paid to insurance company | USD $10,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $681,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $172,838 | | Amount paid for insurance broker fees | 10000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 404W92 |
| Policy instance | 5 |
| Insurance contract or identification number | 404W92 | | Number of Individuals Covered | 620 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $21,905 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,905 | | Insurance broker organization code? | 3 | | Insurance broker name | TOTAL BENEFIT SOLUTION |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350712 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-350712 | | Number of Individuals Covered | 5328 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $36,718 | | Total amount of fees paid to insurance company | USD $2,281 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $367,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,718 | | Amount paid for insurance broker fees | 2281 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-350712 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-350712 | | Number of Individuals Covered | 3861 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,204 | | Total amount of fees paid to insurance company | USD $1,000 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $262,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $26,204 | | Amount paid for insurance broker fees | 1000 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 19922 |
| Policy instance | 3 |
| Insurance contract or identification number | 19922 | | Number of Individuals Covered | 5174 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $166,365 | | Total amount of fees paid to insurance company | USD $12,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $615,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $166,365 | | Amount paid for insurance broker fees | 12000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 4 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 3256 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $40,685 | | Total amount of fees paid to insurance company | USD $2,651 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $271,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,685 | | Amount paid for insurance broker fees | 2651 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F019109 |
| Policy instance | 1 |
| Insurance contract or identification number | F019109 | | Number of Individuals Covered | 2343 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $136,236 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $793,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $136,236 | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 3 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 3230 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $39,765 | | Total amount of fees paid to insurance company | USD $12,863 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 2 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 2459 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $119,726 | | Total amount of fees paid to insurance company | USD $15,000 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $798,171 | | 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 number | 19922 |
| Policy instance | 1 |
| Insurance contract or identification number | 19922 | | Number of Individuals Covered | 5288 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $776,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 3 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 3287 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $38,590 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $257,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,590 | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 19922 |
| Policy instance | 1 |
| Insurance contract or identification number | 19922 | | Number of Individuals Covered | 5408 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $190,977 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $694,957 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 3 |
| Policy instance | 2 |
| Insurance contract or identification number | 3 | | Number of Individuals Covered | 2508 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $113,562 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $757,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $113,562 | | Insurance broker organization code? | 3 | | Insurance broker name | BILL HARTSFIELD & ASSOCIATES |
|
