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HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan NameHARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number 501

HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT 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

HARGIS INDUSTRIES, L.P. has sponsored the creation of one or more 401k plans.

Company Name:HARGIS INDUSTRIES, L.P.
Employer identification number (EIN):751587401
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01
5012018-01-01
5012017-01-01ERICKI PEARCE
5012016-01-01ERICKI PEARCE
5012015-01-01ERICKI PEARCE
5012014-01-01BRUCE CROUCH
5012013-01-01BRUCE CROUCH
5012011-01-01BRUCE CROUCH
5012010-01-01BRUCE CROUCH
5012009-01-01BRUCE CROUCH

Plan Statistics for HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2019: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01177
Total of all active and inactive participants2019-01-010
Total participants2019-01-010
2018: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01164
Total number of active participants reported on line 7a of the Form 55002018-01-01177
Total of all active and inactive participants2018-01-01177
Total participants2018-01-01177
2017: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01184
Total number of active participants reported on line 7a of the Form 55002017-01-01164
Total of all active and inactive participants2017-01-01164
Total participants2017-01-01164
2016: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01161
Total number of active participants reported on line 7a of the Form 55002016-01-01184
Total of all active and inactive participants2016-01-01184
Total participants2016-01-01184
2015: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01154
Total number of active participants reported on line 7a of the Form 55002015-01-01161
Total of all active and inactive participants2015-01-01161
Total participants2015-01-010
2014: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01156
Total number of active participants reported on line 7a of the Form 55002014-01-01154
Total of all active and inactive participants2014-01-01154
Total participants2014-01-010
2013: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01156
Total number of active participants reported on line 7a of the Form 55002013-01-01156
Total of all active and inactive participants2013-01-01156
Total participants2013-01-010
2011: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01131
Total number of active participants reported on line 7a of the Form 55002011-01-01123
Total of all active and inactive participants2011-01-01123
Total participants2011-01-01123
2010: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01131
Total number of active participants reported on line 7a of the Form 55002010-01-01131
Total of all active and inactive participants2010-01-01131
Total participants2010-01-01131
2009: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01121
Total number of active participants reported on line 7a of the Form 55002009-01-01121
Total of all active and inactive participants2009-01-01121
Total participants2009-01-01121

Financial Data on HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2018 : HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k financial data
Value of total assets at end of year2018-12-31$0
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 bond2018-12-31No
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
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
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
Value of interest in pooled separate accounts at end of year2018-12-31$0
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
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
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 PBGC2018-12-31No

Form 5500 Responses for HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN

2019: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01This submission is the final filingYes
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: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: HARGIS INDUSTRIES, L.P. EMPLOYEE HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4941449
Policy instance 1
Insurance contract or identification numberE4941449
Number of Individuals Covered150
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,323
Total amount of fees paid to insurance companyUSD $562
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,042
Amount paid for insurance broker fees544
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number331161
Policy instance 3
Insurance contract or identification number331161
Number of Individuals Covered172
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $3,044
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, LIFE, LT DIS, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $21,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,044
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4941449
Policy instance 2
Insurance contract or identification numberE4941449
Number of Individuals Covered150
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $11,433
Total amount of fees paid to insurance companyUSD $6,951
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,069
Amount paid for insurance broker fees3751
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNIS114002
Policy instance 1
Insurance contract or identification numberNIS114002
Number of Individuals Covered177
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedSPECIFIC & AGGREGATE REINSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $168,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL 1000405 00
Policy instance 1
Insurance contract or identification numberESL 1000405 00
Number of Individuals Covered161
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $51,159
Other welfare benefits providedSPECIFIC & AGGREGATE REINSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $199,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees51159
Insurance broker nameFLEXIBLE BENEFIT GROUP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number331161
Policy instance 3
Insurance contract or identification number331161
Number of Individuals Covered164
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $5,000
Total amount of fees paid to insurance companyUSD $1,341
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, LIFE, LT DIS, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $34,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,000
Amount paid for insurance broker fees1341
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameINSURORS OF TEXAS GENERAL AGENT
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7507338
Policy instance 2
Insurance contract or identification numberE7507338
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $16,509
Total amount of fees paid to insurance companyUSD $6,231
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,800
Amount paid for insurance broker fees5799
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameLISA LAWSON
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7507338
Policy instance 2
Insurance contract or identification numberE7507338
Number of Individuals Covered138
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,666
Total amount of fees paid to insurance companyUSD $2,552
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,523
Amount paid for insurance broker fees2452
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameRAYMOND ROBERTS SEIFERT JR.
GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number331161
Policy instance 3
Insurance contract or identification number331161
Number of Individuals Covered161
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $5,384
Total amount of fees paid to insurance companyUSD $1,401
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, LIFE, LT DIS, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $38,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,384
Amount paid for insurance broker fees1401
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameINSURORS OF TEXAS GENERAL AGENT
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS00900-13
Policy instance 1
Insurance contract or identification numberLGS00900-13
Number of Individuals Covered149
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $43,035
Other welfare benefits providedSPECIFIC & AGGREGATE REINSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $180,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,035
Insurance broker nameFLEXIBLE BENEFIT GROUP
GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberBG819
Policy instance 3
Insurance contract or identification numberBG819
Number of Individuals Covered152
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $5,247
Total amount of fees paid to insurance companyUSD $713
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $36,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,247
Amount paid for insurance broker fees713
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameINSURORS OF TEXAS GENERAL AGENT
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7507338
Policy instance 2
Insurance contract or identification numberE7507338
Number of Individuals Covered136
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,779
Total amount of fees paid to insurance companyUSD $4,969
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,066
Amount paid for insurance broker fees4818
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameREBECCA G DEJESUS
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS00900-13
Policy instance 1
Insurance contract or identification numberLGS00900-13
Number of Individuals Covered156
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Other welfare benefits providedSPECIFIC & AGGREGATE REINSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $188,484
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: 39217 )
Policy contract numberLGS00900-13
Policy instance 1
Insurance contract or identification numberLGS00900-13
Number of Individuals Covered156
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Other welfare benefits providedSPECIFIC & AGGREGATE REINSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $191,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberBG819
Policy instance 3
Insurance contract or identification numberBG819
Number of Individuals Covered153
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $5,439
Total amount of fees paid to insurance companyUSD $1,005
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $37,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,439
Amount paid for insurance broker fees1005
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameINSURORS OF TEXAS GENERAL AGENT
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7507338
Policy instance 2
Insurance contract or identification numberE7507338
Number of Individuals Covered128
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,670
Total amount of fees paid to insurance companyUSD $5,174
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,925
Amount paid for insurance broker fees4923
Additional information about fees paid to insurance brokerCONSULTING FEES
Insurance broker organization code?3
Insurance broker nameGARY S DUNCAN
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL20573
Policy instance 1
Insurance contract or identification numberHCL20573
Number of Individuals Covered123
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $22,074
Total amount of fees paid to insurance companyUSD $11,971
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL20573
Policy instance 1
Insurance contract or identification numberHCL20573
Number of Individuals Covered131
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $22,128
Total amount of fees paid to insurance companyUSD $13,059
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,128
Amount paid for insurance broker fees13059
Additional information about fees paid to insurance brokerCONSULTANTS FEES
Insurance broker organization code?3
Insurance broker nameFLEXIBLE BENEFIT GROUP

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