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POTTER CONCRETE CAFETERIA PLAN 401k Plan overview

Plan NamePOTTER CONCRETE CAFETERIA PLAN
Plan identification number 501

POTTER CONCRETE CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

POTTER CONCRETE, LTD. has sponsored the creation of one or more 401k plans.

Company Name:POTTER CONCRETE, LTD.
Employer identification number (EIN):752908373
NAIC Classification:238100

Additional information about POTTER CONCRETE, LTD.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2000-11-01
Company Identification Number: 0014170510
Legal Registered Office Address: 2400 E PIONEER DR

IRVING
United States of America (USA)
75061

More information about POTTER CONCRETE, LTD.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POTTER CONCRETE CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01JOHN C CAFFEY2023-03-31
5012020-10-01JOHN C. CAFFEY2022-04-27
5012019-10-01JOHN C. CAFFEY2021-04-26
5012018-10-01JOHN C. CAFFEY2020-04-08
5012017-10-01JOHN C. CAFFEY2019-04-30
5012016-10-01
5012015-10-01
5012015-10-01JOHN C.CAFFEY2017-04-28
5012014-10-01
5012014-01-01JOHN C. CAFFEY JOHN C. CAFFEY2015-06-17
5012013-01-01JOHN C. CAFFEY JOHN C. CAFFEY2014-07-24
5012012-01-01JOHN C. CAFFEY JOHN C. CAFFEY2013-06-20
5012011-01-01JOHN C. CAFFEY JOHN C. CAFFEY2012-07-31
5012009-01-01JOHN C.CAFFEY JOHN C. CAFFEY2010-10-14

Plan Statistics for POTTER CONCRETE CAFETERIA PLAN

401k plan membership statisitcs for POTTER CONCRETE CAFETERIA PLAN

Measure Date Value
2021: POTTER CONCRETE CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01354
Total number of active participants reported on line 7a of the Form 55002021-10-01332
Total of all active and inactive participants2021-10-01332
2020: POTTER CONCRETE CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01491
Total number of active participants reported on line 7a of the Form 55002020-10-01354
Total of all active and inactive participants2020-10-01354
2019: POTTER CONCRETE CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01599
Total number of active participants reported on line 7a of the Form 55002019-10-01491
Total of all active and inactive participants2019-10-01491
2018: POTTER CONCRETE CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01602
Total number of active participants reported on line 7a of the Form 55002018-10-01599
Total of all active and inactive participants2018-10-01599
2017: POTTER CONCRETE CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01397
Total number of active participants reported on line 7a of the Form 55002017-10-01602
Total of all active and inactive participants2017-10-01602
2016: POTTER CONCRETE CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01486
Total number of active participants reported on line 7a of the Form 55002016-10-01397
Total of all active and inactive participants2016-10-01397
2015: POTTER CONCRETE CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01595
Total number of active participants reported on line 7a of the Form 55002015-10-01486
Total of all active and inactive participants2015-10-01486
2014: POTTER CONCRETE CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01258
Total number of active participants reported on line 7a of the Form 55002014-10-01595
Total of all active and inactive participants2014-10-01595
Total participants, beginning-of-year2014-01-01265
Total number of active participants reported on line 7a of the Form 55002014-01-01258
Total of all active and inactive participants2014-01-01258
2013: POTTER CONCRETE CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01145
Total number of active participants reported on line 7a of the Form 55002013-01-01265
Total of all active and inactive participants2013-01-01265
2012: POTTER CONCRETE CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01207
Total number of active participants reported on line 7a of the Form 55002012-01-01145
Total of all active and inactive participants2012-01-01145
2011: POTTER CONCRETE CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01241
Total number of active participants reported on line 7a of the Form 55002011-01-01207
Total of all active and inactive participants2011-01-01207
2009: POTTER CONCRETE CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01509
Total number of active participants reported on line 7a of the Form 55002009-01-01326
Total of all active and inactive participants2009-01-01326

Form 5500 Responses for POTTER CONCRETE CAFETERIA PLAN

2021: POTTER CONCRETE CAFETERIA PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: POTTER CONCRETE CAFETERIA PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: POTTER CONCRETE CAFETERIA PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: POTTER CONCRETE CAFETERIA PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: POTTER CONCRETE CAFETERIA PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: POTTER CONCRETE CAFETERIA PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: POTTER CONCRETE CAFETERIA PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedYes
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: POTTER CONCRETE CAFETERIA PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2014-01-01Type of plan entitySingle employer plan
2014-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: POTTER CONCRETE CAFETERIA PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: POTTER CONCRETE CAFETERIA PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: POTTER CONCRETE CAFETERIA 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
2009: POTTER CONCRETE CAFETERIA PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number309425
Policy instance 3
Insurance contract or identification number309425
Number of Individuals Covered204
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $3,239
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $18,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,239
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number919112
Policy instance 2
Insurance contract or identification number919112
Number of Individuals Covered403
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $17,824
Total amount of fees paid to insurance companyUSD $96,627
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,884,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,824
Amount paid for insurance broker fees96627
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 1
Insurance contract or identification numberE3091337
Number of Individuals Covered321
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $149,970
Total amount of fees paid to insurance companyUSD $40,645
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $699,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,636
Amount paid for insurance broker fees3705
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 2
Insurance contract or identification numberE3091337
Number of Individuals Covered349
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $175,893
Total amount of fees paid to insurance companyUSD $45,479
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $734,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,006
Amount paid for insurance broker fees4516
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number919112
Policy instance 3
Insurance contract or identification number919112
Number of Individuals Covered481
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $92,284
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,754,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees92284
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number916560
Policy instance 1
Insurance contract or identification number916560
Number of Individuals Covered218
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $16,901
Total amount of fees paid to insurance companyUSD $863
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $128,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,901
Amount paid for insurance broker fees863
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number916560
Policy instance 1
Insurance contract or identification number916560
Number of Individuals Covered210
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $17,221
Total amount of fees paid to insurance companyUSD $521
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $129,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,221
Amount paid for insurance broker fees521
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 2
Insurance contract or identification numberE3091337
Number of Individuals Covered373
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $152,708
Total amount of fees paid to insurance companyUSD $38,208
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $779,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $66,128
Amount paid for insurance broker fees10631
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number919112
Policy instance 3
Insurance contract or identification number919112
Number of Individuals Covered318
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $68,061
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,798,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees68061
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number916560
Policy instance 1
Insurance contract or identification number916560
Number of Individuals Covered235
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $17,389
Total amount of fees paid to insurance companyUSD $302
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $133,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,389
Amount paid for insurance broker fees302
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 3
Insurance contract or identification numberE3091337
Number of Individuals Covered421
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $146,123
Total amount of fees paid to insurance companyUSD $28,538
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $555,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,163
Amount paid for insurance broker fees5614
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract number1000853-02
Policy instance 2
Insurance contract or identification number1000853-02
Number of Individuals Covered144
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $3,185
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $46,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,185
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00620024
Policy instance 4
Insurance contract or identification number00620024
Number of Individuals Covered253
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $94,530
Total amount of fees paid to insurance companyUSD $-49,111
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $943,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,530
Amount paid for insurance broker fees-49111
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 4
Insurance contract or identification numberE3091337
Number of Individuals Covered374
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $108,143
Total amount of fees paid to insurance companyUSD $33,346
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $516,585
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 number1200040-00
Policy instance 3
Insurance contract or identification number1200040-00
Number of Individuals Covered261
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $1,135
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $32,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 2
Insurance contract or identification number5426784
Number of Individuals Covered18
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $629
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00620024
Policy instance 5
Insurance contract or identification number00620024
Number of Individuals Covered242
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $92,488
Total amount of fees paid to insurance companyUSD $23,921
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $912,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 1
Insurance contract or identification number5426784
Number of Individuals Covered224
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $15,978
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $119,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 )
Policy contract number00802-15
Policy instance 5
Insurance contract or identification number00802-15
Number of Individuals Covered153
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $6,245
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $73,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0903296
Policy instance 4
Insurance contract or identification number0903296
Number of Individuals Covered312
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $69,865
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,328,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 3
Insurance contract or identification number5426784
Number of Individuals Covered39
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $1,075
Total amount of fees paid to insurance companyUSD $337
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 2
Insurance contract or identification number5426784
Number of Individuals Covered266
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $17,272
Total amount of fees paid to insurance companyUSD $5,130
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $127,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 1
Insurance contract or identification numberE7979206
Number of Individuals Covered51
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $5,969
Total amount of fees paid to insurance companyUSD $1,408
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $5,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0903296
Policy instance 5
Insurance contract or identification number0903296
Number of Individuals Covered206
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $64,583
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,292,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees64583
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY, LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 3
Insurance contract or identification number5426784
Number of Individuals Covered298
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $25,656
Total amount of fees paid to insurance companyUSD $228
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DENTAL & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $181,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,656
Amount paid for insurance broker fees228
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY, LLC
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 4
Insurance contract or identification number5426784
Number of Individuals Covered42
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $945
Total amount of fees paid to insurance companyUSD $12
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $945
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY, LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 2
Insurance contract or identification numberE7979206
Number of Individuals Covered352
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $74,299
Total amount of fees paid to insurance companyUSD $18,322
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $207,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,499
Amount paid for insurance broker fees3705
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameRAYMOND ROBERTS SEIFERT, JR
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 1
Insurance contract or identification numberE3091337
Number of Individuals Covered639
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $15,036
Total amount of fees paid to insurance companyUSD $4,603
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $39,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,163
Amount paid for insurance broker fees772
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameREBECCA G DEJESUS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 1
Insurance contract or identification numberE3091337
Number of Individuals Covered11
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $1,219
Total amount of fees paid to insurance companyUSD $232
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $12,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $313
Amount paid for insurance broker fees26
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDONNELL EUGENE STANLEY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 2
Insurance contract or identification numberE7979206
Number of Individuals Covered132
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $35,363
Total amount of fees paid to insurance companyUSD $6,276
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $116,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,413
Amount paid for insurance broker fees863
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVID EVANS
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 3
Insurance contract or identification number5426784
Number of Individuals Covered182
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $16,386
Total amount of fees paid to insurance companyUSD $4,397
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DENTAL & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $113,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,386
Amount paid for insurance broker fees4397
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker namePRESCOTT PAILET BEN A MARSH & MCLEN
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 4
Insurance contract or identification number5426784
Number of Individuals Covered42
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $911
Total amount of fees paid to insurance companyUSD $226
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $911
Amount paid for insurance broker fees226
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker namePRESCOTT PAILET BEN A MARSH & MCLEN
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 6
Insurance contract or identification numberE3091337
Number of Individuals Covered13
Insurance policy start date2013-07-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $363
Total amount of fees paid to insurance companyUSD $35
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $3,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDONNELL EUGENE STANLEY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 7
Insurance contract or identification numberE7979206
Number of Individuals Covered193
Insurance policy start date2013-07-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,890
Total amount of fees paid to insurance companyUSD $344
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $7,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,594
Amount paid for insurance broker fees124
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVID EVANS
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0847508-SHORT
Policy instance 5
Insurance contract or identification number0847508-SHORT
Number of Individuals Covered230
Insurance policy start date2014-04-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $454,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 3
Insurance contract or identification number5426784
Number of Individuals Covered172
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $15,102
Total amount of fees paid to insurance companyUSD $1,570
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DENTAL & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $104,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,513
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
Insurance broker namePRESCOTT PAILET BEN A MARSH & MCLEN
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number714058
Policy instance 5
Insurance contract or identification number714058
Number of Individuals Covered208
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $37,796
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $724,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,796
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BENEFITS INC.
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 4
Insurance contract or identification number5426784
Number of Individuals Covered32
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $849
Total amount of fees paid to insurance companyUSD $87
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $707
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
Insurance broker namePRESCOTT PAILET BEN A MARSH & MCLEN
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 2
Insurance contract or identification numberE7979206
Number of Individuals Covered75
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $6,951
Total amount of fees paid to insurance companyUSD $1,171
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $38,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,438
Amount paid for insurance broker fees230
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVID EVANS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 1
Insurance contract or identification numberE3091337
Number of Individuals Covered14
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,786
Total amount of fees paid to insurance companyUSD $395
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $14,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $633
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameGRACIELA V FERNANDEZ-NEWELL
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number714058
Policy instance 5
Insurance contract or identification number714058
Number of Individuals Covered262
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $24,066
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $741,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,066
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 3
Insurance contract or identification number5426784
Number of Individuals Covered179
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $14,555
Total amount of fees paid to insurance companyUSD $760
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DENTAL & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $100,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,555
Amount paid for insurance broker fees760
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 4
Insurance contract or identification number5426784
Number of Individuals Covered29
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $679
Total amount of fees paid to insurance companyUSD $35
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $679
Amount paid for insurance broker fees35
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 1
Insurance contract or identification numberE3091337
Number of Individuals Covered16
Insurance policy start date2011-05-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,085
Total amount of fees paid to insurance companyUSD $466
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $16,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $882
Amount paid for insurance broker fees42
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameFRANCISCO X CABRERA
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 2
Insurance contract or identification numberE7979206
Number of Individuals Covered92
Insurance policy start date2011-05-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $11,512
Total amount of fees paid to insurance companyUSD $2,053
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $36,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,339
Amount paid for insurance broker fees215
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameMARTHA GUTIERREZ
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 3
Insurance contract or identification numberE3091337
Number of Individuals Covered16
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $1,950
Total amount of fees paid to insurance companyUSD $233
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $22,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 2
Insurance contract or identification number5426784
Number of Individuals Covered81
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $7,764
Total amount of fees paid to insurance companyUSD $501
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $52,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 7
Insurance contract or identification number5426784
Number of Individuals Covered19
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $561
Total amount of fees paid to insurance companyUSD $52
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 4
Insurance contract or identification numberE7979206
Number of Individuals Covered51
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $2,284
Total amount of fees paid to insurance companyUSD $246
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $25,248
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 number000010102312
Policy instance 5
Insurance contract or identification number000010102312
Number of Individuals Covered144
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,266
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,441
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 number00040E001000
Policy instance 6
Insurance contract or identification number00040E001000
Number of Individuals Covered70
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $5,733
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0714058
Policy instance 1
Insurance contract or identification number0714058
Number of Individuals Covered229
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $41,682
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $833,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3091337
Policy instance 3
Insurance contract or identification numberE3091337
Number of Individuals Covered44
Insurance policy start date2009-04-02
Insurance policy end date2010-04-01
Total amount of commissions paid to insurance brokerUSD $5,471
Total amount of fees paid to insurance companyUSD $386
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $35,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,163
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameDAVID EVANS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7979206
Policy instance 4
Insurance contract or identification numberE7979206
Number of Individuals Covered45
Insurance policy start date2009-04-02
Insurance policy end date2010-04-01
Total amount of commissions paid to insurance brokerUSD $2,212
Total amount of fees paid to insurance companyUSD $133
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $20,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $940
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameDAVID EVANS
UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 )
Policy contract number5426784
Policy instance 7
Insurance contract or identification number5426784
Number of Individuals Covered10
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $379
Total amount of fees paid to insurance companyUSD $27
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $379
Amount paid for insurance broker fees27
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040E001000
Policy instance 6
Insurance contract or identification number00040E001000
Number of Individuals Covered81
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $8,791
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $58,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,791
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010102312
Policy instance 5
Insurance contract or identification number000010102312
Number of Individuals Covered166
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $1,988
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,988
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0714058
Policy instance 1
Insurance contract or identification number0714058
Number of Individuals Covered305
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $49,269
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $985,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,269
Insurance broker nameINDEPENDENT INS GROUP BEN INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5426784
Policy instance 2
Insurance contract or identification number5426784
Number of Individuals Covered107
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $11,306
Total amount of fees paid to insurance companyUSD $539
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $75,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,306
Amount paid for insurance broker fees539
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameINDEPENDENT INS GROUP BEN INC.

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