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MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 401k Plan overview

Plan NameMUELLER SUPPLY COMPANY, INC. HEALTH PLAN
Plan identification number 511

MUELLER SUPPLY COMPANY, INC. HEALTH PLAN Benefits

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

401k Sponsoring company profile

MUELLER SUPPLY COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:MUELLER SUPPLY COMPANY, INC.
Employer identification number (EIN):751388946
NAIC Classification:551112
NAIC Description:Offices of Other Holding Companies

Additional information about MUELLER SUPPLY COMPANY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1984-05-29
Company Identification Number: 0070637500
Legal Registered Office Address: 1915 HUTCHINS AVE

BALLINGER
United States of America (USA)
76821

More information about MUELLER SUPPLY COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MUELLER SUPPLY COMPANY, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112020-01-01
5112019-01-01
5112018-01-01
5112017-01-01JEFF BENTON
5112016-04-01JEFF BENTON

Plan Statistics for MUELLER SUPPLY COMPANY, INC. HEALTH PLAN

401k plan membership statisitcs for MUELLER SUPPLY COMPANY, INC. HEALTH PLAN

Measure Date Value
2020: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01724
Total number of active participants reported on line 7a of the Form 55002020-01-010
Total of all active and inactive participants2020-01-010
2019: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01742
Number of retired or separated participants receiving benefits2019-01-01724
Total of all active and inactive participants2019-01-01724
2018: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01762
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
2017: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01752
Total number of active participants reported on line 7a of the Form 55002017-01-01762
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01762
2016: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-010
Total number of active participants reported on line 7a of the Form 55002016-04-011,718
Total of all active and inactive participants2016-04-011,718
Total participants2016-04-011,718

Financial Data on MUELLER SUPPLY COMPANY, INC. HEALTH PLAN

Measure Date Value
2018 : MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2018 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$666,191
Total income from all sources (including contributions)2018-12-31$6,313,463
Total of all expenses incurred2018-12-31$7,547,145
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$6,574,238
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$6,313,463
Value of total assets at beginning of year2018-12-31$1,899,873
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$972,907
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$50,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$635,084
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$23,356
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$64,071
Liabilities. Value of operating payables at beginning of year2018-12-31$144,852
Total non interest bearing cash at beginning of year2018-12-31$1,046,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-1,233,682
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,233,682
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$714,021
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$5,655,023
Employer contributions (assets) at beginning of year2018-12-31$788,881
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$5,860,217
Contract administrator fees2018-12-31$972,907
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$521,339
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31EIDE BAILLY, LLP
Accountancy firm EIN2018-12-31450250958
2017 : MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$666,191
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$910,380
Total income from all sources (including contributions)2017-12-31$8,602,283
Total of all expenses incurred2017-12-31$7,914,960
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$6,950,050
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$8,601,385
Value of total assets at end of year2017-12-31$1,899,873
Value of total assets at beginning of year2017-12-31$1,456,739
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$964,910
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$420,230
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$14,209
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$64,071
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$55,878
Other income not declared elsewhere2017-12-31$898
Liabilities. Value of operating payables at end of year2017-12-31$144,852
Liabilities. Value of operating payables at beginning of year2017-12-31$92,855
Total non interest bearing cash at end of year2017-12-31$1,046,921
Total non interest bearing cash at beginning of year2017-12-31$834,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$687,323
Value of net assets at end of year (total assets less liabilities)2017-12-31$1,233,682
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$546,359
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$752,726
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$8,166,946
Employer contributions (assets) at end of year2017-12-31$788,881
Employer contributions (assets) at beginning of year2017-12-31$566,213
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$6,197,324
Contract administrator fees2017-12-31$964,910
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$521,339
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$817,525
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31EIDE BAILLY LLP
Accountancy firm EIN2017-12-31450250958
2016 : MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2016 401k financial data
Total transfer of assets to this plan2016-12-31$936,769
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$910,380
Total income from all sources (including contributions)2016-12-31$7,110,520
Total of all expenses incurred2016-12-31$7,500,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$6,864,850
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$7,110,520
Value of total assets at end of year2016-12-31$1,456,739
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$636,080
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$21,886
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$406,950
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$364,408
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$55,878
Administrative expenses (other) incurred2016-12-31$68,789
Liabilities. Value of operating payables at end of year2016-12-31$92,855
Total non interest bearing cash at end of year2016-12-31$834,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-390,410
Value of net assets at end of year (total assets less liabilities)2016-12-31$546,359
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in common/collective trusts at end of year2016-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$629,079
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$6,339,162
Employer contributions (assets) at end of year2016-12-31$566,213
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$6,235,771
Contract administrator fees2016-12-31$545,405
Liabilities. Value of benefit claims payable at end of year2016-12-31$817,525
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31DAVIS KINARD & CO, PC
Accountancy firm EIN2016-12-31751332266

Form 5500 Responses for MUELLER SUPPLY COMPANY, INC. HEALTH PLAN

2020: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingYes
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: MUELLER SUPPLY COMPANY, INC. HEALTH 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: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MUELLER SUPPLY COMPANY, INC. HEALTH PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01First time form 5500 has been submittedYes
2016-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number074288
Policy instance 4
Insurance contract or identification number074288
Number of Individuals Covered954
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,848
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $317,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5848
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236354
Policy instance 3
Insurance contract or identification number000010236354
Number of Individuals Covered745
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,335
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $117,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1326
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHCSCO-028
Policy instance 2
Insurance contract or identification numberHCSCO-028
Number of Individuals Covered736
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $15,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236355
Policy instance 1
Insurance contract or identification number000010236355
Number of Individuals Covered745
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,858
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1623
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236355
Policy instance 1
Insurance contract or identification number000010236355
Number of Individuals Covered737
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,891
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2891
Additional information about fees paid to insurance broker2,082.73 FEES. 808.57 BONUS.
Insurance broker organization code?3
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHCSCO-028
Policy instance 2
Insurance contract or identification numberHCSCO-028
Number of Individuals Covered728
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $15,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236354
Policy instance 3
Insurance contract or identification number000010236354
Number of Individuals Covered737
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,362
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $113,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2362
Additional information about fees paid to insurance broker1,702.29 FEES. 659.48 BONUS.
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236354
Policy instance 5
Insurance contract or identification number000010236354
Number of Individuals Covered747
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,692
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $110,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7692
Additional information about fees paid to insurance brokerBONUS
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number074288
Policy instance 4
Insurance contract or identification number074288
Number of Individuals Covered1735
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,782
Health 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 fees2782
Additional information about fees paid to insurance brokerBONUS
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHCSCO-028
Policy instance 3
Insurance contract or identification numberHCSCO-028
Number of Individuals Covered739
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $16,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberLGS01261-17
Policy instance 2
Insurance contract or identification numberLGS01261-17
Number of Individuals Covered745
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $779,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010236355
Policy instance 1
Insurance contract or identification number000010236355
Number of Individuals Covered747
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $9,407
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $135,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees9407
Additional information about fees paid to insurance brokerBONUS
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number074288
Policy instance 4
Insurance contract or identification number074288
Number of Individuals Covered1745
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,747
Health 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 fees3747
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberHCSCO-028
Policy instance 3
Insurance contract or identification numberHCSCO-028
Number of Individuals Covered762
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $16,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberLGS01261-17
Policy instance 2
Insurance contract or identification numberLGS01261-17
Number of Individuals Covered740
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $752,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00522628
Policy instance 1
Insurance contract or identification number00522628
Number of Individuals Covered762
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,516
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $222,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7516
Insurance broker nameMARSH & MCLENNAN AGENCY LLC

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