NYSARC, INC. NASSAU COUNTY CHAPTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NYSARC INC. - NASSAU COUNTY CHAPTER EMPLOYEE WELFA
401k plan membership statisitcs for NYSARC INC. - NASSAU COUNTY CHAPTER EMPLOYEE WELFA
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 3 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 323 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $1,455 | Total amount of fees paid to insurance company | USD $14,118 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $54,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,455 | Amount paid for insurance broker fees | 14118 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 1 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 325 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $30,083 | Total amount of fees paid to insurance company | USD $868 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $201,779 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,433 | Amount paid for insurance broker fees | 66 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 2 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2088 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $5,735 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $347,183 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,735 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 4 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 5 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $394 | Total amount of fees paid to insurance company | USD $69 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,711 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $124 | Amount paid for insurance broker fees | 51 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 5 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 87 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $11,867 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $59,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,867 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 6 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 162 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $12,277 | Total amount of fees paid to insurance company | USD $4,911 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE, VOL SPOUSE LIFE & VOL CHILD LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $122,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,277 | Amount paid for insurance broker fees | 4911 | Additional information about fees paid to insurance broker | MEMBER SURVEYS, PREMIUM COLL., MATERIAL PREP. | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 7 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 258 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $10,676 | Total amount of fees paid to insurance company | USD $4,271 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $106,764 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,676 | Amount paid for insurance broker fees | 4271 | Additional information about fees paid to insurance broker | MEMBER SURVEYS, PREMIUM COLL., MATERIAL PREP. | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 8 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $223 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,685 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $174 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 9 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 90 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $10,534 | Total amount of fees paid to insurance company | USD $484 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $69,618 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,486 | Amount paid for insurance broker fees | 36 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 300605 |
Policy instance | 14 |
Insurance contract or identification number | 300605 | Number of Individuals Covered | 2244 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $789 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,038,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $789 | Insurance broker organization code? | 3 |
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CIGNA DENTAL HEALTH OF NORTH CAROLINA, INC. (National Association of Insurance Commissioners NAIC id number: 95179 ) |
Policy contract number | 2498904-7 |
Policy instance | 13 |
Insurance contract or identification number | 2498904-7 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10235948 |
Policy instance | 12 |
Insurance contract or identification number | 10235948 | Number of Individuals Covered | 72 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,450 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,002 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,450 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 11 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 100 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $11,869 | Total amount of fees paid to insurance company | USD $232 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $71,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,515 | Amount paid for insurance broker fees | 18 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1102821000 |
Policy instance | 10 |
Insurance contract or identification number | 1102821000 | Number of Individuals Covered | 25 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $11,050 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $350,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,050 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 1 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 278 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $35,460 | Total amount of fees paid to insurance company | USD $234 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $210,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 5 | Additional information about fees paid to insurance broker | FEES |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 2 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2032 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,755 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $230,023 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,755 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 4 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 4 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,143 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,461 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $416 | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 5 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 94 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $7,608 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $38,041 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,608 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 6 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 169 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $15,084 | Total amount of fees paid to insurance company | USD $6,033 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE, VOL SPOUSE LIFE & VOL CHILD LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $150,833 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,084 | Amount paid for insurance broker fees | 6033 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 7 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 277 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $9,112 | Total amount of fees paid to insurance company | USD $3,645 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | WEEKLY INCOME | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $91,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,112 | Amount paid for insurance broker fees | 3645 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 8 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $190 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $147 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 3 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 2528 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $423,799 | Total amount of fees paid to insurance company | USD $15,562 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,072,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $423,799 | Amount paid for insurance broker fees | 15562 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10235948 |
Policy instance | 12 |
Insurance contract or identification number | 10235948 | Number of Individuals Covered | 80 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,488 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,381 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,488 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 11 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 107 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $14,054 | Total amount of fees paid to insurance company | USD $45 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $88,160 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,711 | Amount paid for insurance broker fees | 9 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1102821001 |
Policy instance | 10 |
Insurance contract or identification number | 1102821001 | Number of Individuals Covered | 30 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $10,747 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $373,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,747 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 9 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 92 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $12,017 | Total amount of fees paid to insurance company | USD $89 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $68,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,858 | Amount paid for insurance broker fees | 20 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 1 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 302 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $27,573 | Total amount of fees paid to insurance company | USD $622 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $183,333 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,296 | Amount paid for insurance broker fees | 240 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 2 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2287 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $4,592 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $191,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,592 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 3 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 2743 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $1,373 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $915,692 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,373 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 4 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 6 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $987 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,723 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $543 | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 5 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 102 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-28 | Total amount of commissions paid to insurance broker | USD $9,442 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $47,212 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,442 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 6 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 183 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $13,595 | Total amount of fees paid to insurance company | USD $5,438 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $135,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,595 | Amount paid for insurance broker fees | 5438 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 7 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 317 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $9,426 | Total amount of fees paid to insurance company | USD $3,770 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | WEEKLY INCOME | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $94,263 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,426 | Amount paid for insurance broker fees | 3770 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 8 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $223 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,685 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $174 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 9 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 107 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,718 | Total amount of fees paid to insurance company | USD $83 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $58,241 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,804 | Amount paid for insurance broker fees | 43 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 11 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 129 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $14,457 | Total amount of fees paid to insurance company | USD $492 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $99,616 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,419 | Amount paid for insurance broker fees | 284 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1102821000 |
Policy instance | 10 |
Insurance contract or identification number | 1102821000 | Number of Individuals Covered | 36 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $11,377 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $390,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,377 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 9 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 108 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $8,320 | Total amount of fees paid to insurance company | USD $298 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $60,460 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,574 | Amount paid for insurance broker fees | 252 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 8 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $190 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $147 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 7 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 323 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $6,842 | Total amount of fees paid to insurance company | USD $2,737 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $68,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,842 | Amount paid for insurance broker fees | 2737 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 5 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 108 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $10,623 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $53,117 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,623 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 6 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 191 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $12,210 | Total amount of fees paid to insurance company | USD $4,884 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $122,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,210 | Amount paid for insurance broker fees | 4884 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 4 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 5 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $268 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $51 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 1 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 305 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $37,715 | Total amount of fees paid to insurance company | USD $807 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $214,793 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,396 | Amount paid for insurance broker fees | 502 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 2 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2297 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,150 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $162,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,150 | Insurance broker organization code? | 3 |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1102821000 |
Policy instance | 10 |
Insurance contract or identification number | 1102821000 | Number of Individuals Covered | 35 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $13,634 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $354,487 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,634 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 11 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 138 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $16,225 | Total amount of fees paid to insurance company | USD $189 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $90,405 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,068 | Amount paid for insurance broker fees | 157 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 3 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 2702 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $1,473 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $852,666 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,473 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 2 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2276 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $4,624 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $186,140 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,624 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 11 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 148 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $14,642 | Total amount of fees paid to insurance company | USD $162 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $95,142 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,807 | Amount paid for insurance broker fees | 28 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 9 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 78 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $9,735 | Total amount of fees paid to insurance company | USD $429 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $54,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,142 | Amount paid for insurance broker fees | 68 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 4 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 6 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $332 | Total amount of fees paid to insurance company | USD $4 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,910 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57 | Amount paid for insurance broker fees | 2 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133001 |
Policy instance | 10 |
Insurance contract or identification number | 1071133001 | Number of Individuals Covered | 9 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $2,961 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $74,033 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,961 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 8 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $207 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $161 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 3 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 2965 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $1,942 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | PREPAID DENTAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $814,965 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,942 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 7 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 329 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,696 | Total amount of fees paid to insurance company | USD $3,078 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $76,960 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,696 | Amount paid for insurance broker fees | 3078 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 6 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 194 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $12,925 | Total amount of fees paid to insurance company | USD $5,170 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $129,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,925 | Amount paid for insurance broker fees | 5170 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 5 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 111 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $10,430 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $52,150 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,430 | Insurance broker organization code? | 3 |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 1 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 314 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $34,843 | Total amount of fees paid to insurance company | USD $885 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $199,696 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,354 | Amount paid for insurance broker fees | 251 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | 119978 |
Policy instance | 11 |
Insurance contract or identification number | 119978 | Number of Individuals Covered | 114 | Insurance policy start date | 2016-11-01 | Insurance policy end date | 2017-10-31 | Total amount of commissions paid to insurance broker | USD $2,874 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,160 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,893 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 1 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 140 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $14,910 | Total amount of fees paid to insurance company | USD $775 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $100,146 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,684 | Amount paid for insurance broker fees | 554 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | MCINERNEY GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 2 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 296 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $33,625 | Total amount of fees paid to insurance company | USD $1,094 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $190,094 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,530 | Amount paid for insurance broker fees | 917 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | KIRSTEN WALSH |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 3 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2441 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $4,605 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $181,820 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,605 | Insurance broker organization code? | 3 | Insurance broker name | PILOTS BENEFITS GROUP LLC |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 4 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 435 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $1,964 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $73,535 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,418 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 5 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 6 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $418 | Total amount of fees paid to insurance company | USD $34 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,920 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $73 | Amount paid for insurance broker fees | 29 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | BENITO A ROTONDI II INC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 6 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 113 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $11,434 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $57,169 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,841 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 7 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 199 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $13,101 | Total amount of fees paid to insurance company | USD $5,240 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $131,009 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,101 | Amount paid for insurance broker fees | 5240 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | PILOTS BENEFITS GROUP LLC |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 8 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 336 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $7,812 | Total amount of fees paid to insurance company | USD $3,125 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $78,121 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,812 | Amount paid for insurance broker fees | 3125 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NJK47 |
Policy instance | 9 |
Insurance contract or identification number | NJK47 | Number of Individuals Covered | 1 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $207 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $161 | Insurance broker organization code? | 3 | Insurance broker name | BRIAN WHITE |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD56 |
Policy instance | 10 |
Insurance contract or identification number | NBD56 | Number of Individuals Covered | 86 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $10,202 | Total amount of fees paid to insurance company | USD $207 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $51,711 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,863 | Amount paid for insurance broker fees | 153 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 | Insurance broker name | THE MEYER AGENCY LTD |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133001 |
Policy instance | 12 |
Insurance contract or identification number | 1071133001 | Number of Individuals Covered | 8 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $1,574 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | COMPREHENSIVE MEDICAL & SURGICAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $44,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,574 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10198175 |
Policy instance | 11 |
Insurance contract or identification number | 10198175 | Number of Individuals Covered | 334 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $7,566 | Total amount of fees paid to insurance company | USD $5,322 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $75,658 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,566 | Amount paid for insurance broker fees | 5322 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 3 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 303 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $27,710 | Total amount of fees paid to insurance company | USD $424 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,287 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,321 | Amount paid for insurance broker fees | 262 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DOMENICO V MAUTARELLI |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 1 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 8 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $1,325 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $33,308 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,325 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 2 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 158 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $17,189 | Total amount of fees paid to insurance company | USD $92 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $103,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,188 | Amount paid for insurance broker fees | 59 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MOHAMMED M SHERIFF |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 4 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2431 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $4,618 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $174,598 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,295 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 5 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 138 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $3,040 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,311 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,040 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 6 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 609 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $2,552 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $92,738 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,552 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 7 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 5 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $516 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,834 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $244 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 8 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 127 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $11,057 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $55,286 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,695 | Insurance broker name | BWD AGENCY INC. |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 400198174 |
Policy instance | 10 |
Insurance contract or identification number | 400198174 | Number of Individuals Covered | 377 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $11,885 | Total amount of fees paid to insurance company | USD $8,191 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $118,853 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,885 | Amount paid for insurance broker fees | 8191 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | S5921 |
Policy instance | 9 |
Insurance contract or identification number | S5921 | Number of Individuals Covered | 70 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $39,668 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 5 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 152 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $2,692 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,451 | Insurance broker organization code? | 3 | Insurance broker name | HEFFERNAN INSURANCE BROKERS |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 3 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 285 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $27,505 | Total amount of fees paid to insurance company | USD $1,492 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $172,105 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,385 | Amount paid for insurance broker fees | 327 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DONNA M WHITE |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 2 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 150 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $17,701 | Total amount of fees paid to insurance company | USD $1,890 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,638 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,660 | Amount paid for insurance broker fees | 428 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DONNA M WHITE |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 1 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 8 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $1,193 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $32,549 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,193 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6888 |
Policy instance | 10 |
Insurance contract or identification number | AN6888 | Number of Individuals Covered | 3678 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $658,069 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,871,161 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $658,069 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 6 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 629 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $3,255 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $103,691 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,255 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 7 |
Insurance contract or identification number | NBD58 | Number of Individuals Covered | 4 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $229 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,027 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48 | Insurance broker organization code? | 3 | Insurance broker name | KOBER ASSOCIATES LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 8 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 132 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $10,719 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,719 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VG 182653 |
Policy instance | 9 |
Insurance contract or identification number | VG 182653 | Number of Individuals Covered | 67 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $3,985 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $39,844 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,985 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPS 326374 |
Policy instance | 11 |
Insurance contract or identification number | VPS 326374 | Number of Individuals Covered | 359 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $1,829 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | VOLUNTARY SHORT TERM DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $18,294 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,829 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 314857 |
Policy instance | 12 |
Insurance contract or identification number | 314857 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 540482 |
Policy instance | 13 |
Insurance contract or identification number | 540482 | Number of Individuals Covered | 257 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,014 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 10176704 |
Policy instance | 4 |
Insurance contract or identification number | 10176704 | Number of Individuals Covered | 2546 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $5,135 | Total amount of fees paid to insurance company | USD $6,111 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $175,129 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,135 | Amount paid for insurance broker fees | 6111 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00 389158 |
Policy instance | 1 |
Insurance contract or identification number | 00 389158 | Number of Individuals Covered | 25 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $857 | Total amount of fees paid to insurance company | USD $1,307 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,531 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $849 | Insurance broker organization code? | 3 | Insurance broker name | NMP PLANNING CO, INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133003 |
Policy instance | 11 |
Insurance contract or identification number | 1071133003 | Number of Individuals Covered | 77 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $21,216 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $530,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,216 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3331606 |
Policy instance | 13 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 721 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $3,328 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $106,412 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,328 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD58 |
Policy instance | 14 |
Insurance contract or identification number | NBD58 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $249 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,172 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $60 | Insurance broker organization code? | 3 | Insurance broker name | STEPHEN WHITE |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 15 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 132 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $9,591 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $47,955 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,591 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
Policy contract number | 62538-00 |
Policy instance | 17 |
Insurance contract or identification number | 62538-00 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 540482 |
Policy instance | 22 |
Insurance contract or identification number | 540482 | Number of Individuals Covered | 259 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 | Insurance broker name | DAVIS VISION |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VG 182653 |
Policy instance | 16 |
Insurance contract or identification number | VG 182653 | Number of Individuals Covered | 66 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $3,189 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $31,893 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,189 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
Policy contract number | NSH-082 |
Policy instance | 21 |
Insurance contract or identification number | NSH-082 | Number of Individuals Covered | 576 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,197 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,596 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1197 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DAVIS VISION |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6683 |
Policy instance | 18 |
Insurance contract or identification number | AN6683 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133903 |
Policy instance | 12 |
Insurance contract or identification number | 1071133903 | Number of Individuals Covered | 3 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $23,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 314857 |
Policy instance | 20 |
Insurance contract or identification number | 314857 | Number of Individuals Covered | 2975 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $796,074 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,062,463 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $796,074 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 10 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 164 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $2,756 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,059 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,756 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | S5921 |
Policy instance | 19 |
Insurance contract or identification number | S5921 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 3 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 11 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $2,846 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $71,158 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,846 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 900 |
Policy instance | 2 |
Insurance contract or identification number | 1071133 900 | Number of Individuals Covered | 1 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,710 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 000 |
Policy instance | 4 |
Insurance contract or identification number | 1071133 000 | Number of Individuals Covered | 678 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $158,736 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $3,968,396 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $158,736 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 002 |
Policy instance | 5 |
Insurance contract or identification number | 1071133 002 | Number of Individuals Covered | 97 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $24,892 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $622,290 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,892 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFIT GROUP LLC |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000AF12 |
Policy instance | 8 |
Insurance contract or identification number | G000AF12 | Number of Individuals Covered | 324 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-11-01 | Total amount of commissions paid to insurance broker | USD $4,311 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $62,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,311 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 6 |
Insurance contract or identification number | NR985 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $23,729 | Total amount of fees paid to insurance company | USD $292 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $93,416 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,479 | Amount paid for insurance broker fees | 175 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DONNA M WHITE |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 7 |
Insurance contract or identification number | N6472 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $33,728 | Total amount of fees paid to insurance company | USD $138 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $167,569 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,447 | Amount paid for insurance broker fees | 68 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LESLIE J LARSON |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL146279 |
Policy instance | 9 |
Insurance contract or identification number | GL146279 | Number of Individuals Covered | 2245 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $3,581 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $106,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,581 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL146279 |
Policy instance | 6 |
Insurance contract or identification number | GL146279 | Number of Individuals Covered | 2259 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $3,997 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $189,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,997 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133903 |
Policy instance | 9 |
Insurance contract or identification number | 1071133903 | Number of Individuals Covered | 1 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $10,037 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133003 |
Policy instance | 8 |
Insurance contract or identification number | 1071133003 | Number of Individuals Covered | 79 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $19,979 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $499,479 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,979 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 7 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 206 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $2,789 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,557 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,789 | Insurance broker name | BWD AGENCY INC. |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000AF12 |
Policy instance | 5 |
Insurance contract or identification number | G000AF12 | Number of Individuals Covered | 294 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $4,692 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $77,689 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,692 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 002 |
Policy instance | 4 |
Insurance contract or identification number | 1071133 002 | Number of Individuals Covered | 103 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $23,284 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $582,104 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,284 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 000 |
Policy instance | 3 |
Insurance contract or identification number | 1071133 000 | Number of Individuals Covered | 726 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $153,985 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $3,849,615 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $153,985 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00 389158 |
Policy instance | 1 |
Insurance contract or identification number | 00 389158 | Number of Individuals Covered | 26 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,451 | Total amount of fees paid to insurance company | USD $802 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,669 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,427 | Insurance broker organization code? | 3 | Insurance broker name | NMP PLANNING CO, INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 2 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 10 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $2,455 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $61,386 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,455 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VG 182653 |
Policy instance | 11 |
Insurance contract or identification number | VG 182653 | Number of Individuals Covered | 69 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $3,116 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $31,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,116 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 10 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 132 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $9,591 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $47,955 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,591 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 314857 |
Policy instance | 14 |
Insurance contract or identification number | 314857 | Number of Individuals Covered | 2975 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $796,074 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,062,463 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $796,074 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 009 |
Policy instance | 22 |
Insurance contract or identification number | 1004753 009 | Number of Individuals Covered | 3 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,898 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 904 |
Policy instance | 23 |
Insurance contract or identification number | 1004753 904 | Number of Individuals Covered | 2 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,587 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 902 |
Policy instance | 21 |
Insurance contract or identification number | 1004753 902 | Number of Individuals Covered | 1 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,969 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 804 |
Policy instance | 20 |
Insurance contract or identification number | 1004753 804 | Number of Individuals Covered | 707 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $2,818 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,231 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,818 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 704 |
Policy instance | 19 |
Insurance contract or identification number | 1004753 704 | Number of Individuals Covered | 1 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $4 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 004 |
Policy instance | 18 |
Insurance contract or identification number | 1004753 004 | Number of Individuals Covered | 700 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $78,877 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,505,633 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $78,877 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
Policy contract number | D348588 |
Policy instance | 12 |
Insurance contract or identification number | D348588 | Number of Individuals Covered | 2126 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,622 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $92,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,622 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
Policy contract number | D348586 |
Policy instance | 13 |
Insurance contract or identification number | D348586 | Number of Individuals Covered | 653 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,983 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,839 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,983 | Insurance broker organization code? | 3 | Insurance broker name | BWD AGENCY INC. |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 001 |
Policy instance | 15 |
Insurance contract or identification number | 1004753 001 | Number of Individuals Covered | 19 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $2,626 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $116,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,626 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 002 |
Policy instance | 16 |
Insurance contract or identification number | 1004753 002 | Number of Individuals Covered | 353 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $36,279 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,612,405 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,279 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1004753 003 |
Policy instance | 17 |
Insurance contract or identification number | 1004753 003 | Number of Individuals Covered | 1432 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $162,239 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,210,643 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $162,239 | Insurance broker organization code? | 3 | Insurance broker name | SOLID BENEFIT GUIDENCE LLC |
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FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL146279 |
Policy instance | 10 |
Insurance contract or identification number | GL146279 | Number of Individuals Covered | 2286 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,336 | Total amount of fees paid to insurance company | USD $6,780 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $191,245 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | S5921 |
Policy instance | 22 |
Insurance contract or identification number | S5921 | Number of Individuals Covered | 31 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $13,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6683 |
Policy instance | 21 |
Insurance contract or identification number | AN6683 | Number of Individuals Covered | 2657 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $512,780 | Total amount of fees paid to insurance company | USD $43,768 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,552,394 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
Policy contract number | D348588 |
Policy instance | 19 |
Insurance contract or identification number | D348588 | Number of Individuals Covered | 2136 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $5,614 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $94,574 | 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 number | 62538-00 |
Policy instance | 18 |
Insurance contract or identification number | 62538-00 | Number of Individuals Covered | 3 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $99 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VG 182653 |
Policy instance | 17 |
Insurance contract or identification number | VG 182653 | Number of Individuals Covered | 66 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $2,463 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $24,626 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | VPL 300857 |
Policy instance | 16 |
Insurance contract or identification number | VPL 300857 | Number of Individuals Covered | 101 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $7,575 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,875 | 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 number | 00 389158 |
Policy instance | 1 |
Insurance contract or identification number | 00 389158 | Number of Individuals Covered | 26 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $2,107 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,049 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 900 |
Policy instance | 2 |
Insurance contract or identification number | 1071133 900 | Number of Individuals Covered | 3 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $39,665 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 3 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 11 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $2,490 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $62,250 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 000 |
Policy instance | 4 |
Insurance contract or identification number | 1071133 000 | Number of Individuals Covered | 715 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $161,136 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,033,792 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 002 |
Policy instance | 5 |
Insurance contract or identification number | 1071133 002 | Number of Individuals Covered | 95 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $8,723 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $218,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6683 |
Policy instance | 6 |
Insurance contract or identification number | AN6683 | Number of Individuals Covered | 2658 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $54,878 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,448,678 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 7 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 151 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $18,261 | Total amount of fees paid to insurance company | USD $1,705 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $73,786 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 8 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 340 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $57,855 | Total amount of fees paid to insurance company | USD $2,127 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $168,496 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000AF12 |
Policy instance | 9 |
Insurance contract or identification number | G000AF12 | Number of Individuals Covered | 309 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $7,828 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $87,425 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD5B |
Policy instance | 15 |
Insurance contract or identification number | NBD5B | Number of Individuals Covered | 3 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $367 | Total amount of fees paid to insurance company | USD $16 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3331606 |
Policy instance | 14 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 1922 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $46,335 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,170,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133903 |
Policy instance | 13 |
Insurance contract or identification number | 1071133903 | Number of Individuals Covered | 2 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $11,377 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133003 |
Policy instance | 12 |
Insurance contract or identification number | 1071133003 | Number of Individuals Covered | 99 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $21,022 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $525,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 11 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 176 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,696 | Total amount of fees paid to insurance company | USD $3,212 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,336 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
Policy contract number | D348586 |
Policy instance | 20 |
Insurance contract or identification number | D348586 | Number of Individuals Covered | 646 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $2,982 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,098 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6683 |
Policy instance | 8 |
Insurance contract or identification number | AN6683 | Number of Individuals Covered | 2582 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $539,225 | Total amount of fees paid to insurance company | USD $240,260 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,549,402 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 002 |
Policy instance | 7 |
Insurance contract or identification number | 1071133 002 | Number of Individuals Covered | 6 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $1,223 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $30,580 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 000 |
Policy instance | 6 |
Insurance contract or identification number | 1071133 000 | Number of Individuals Covered | 847 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $146,844 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $3,671,092 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 5 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 10 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $1,830 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $45,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 900 |
Policy instance | 4 |
Insurance contract or identification number | 1071133 900 | Number of Individuals Covered | 3 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $21,381 | 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 number | 00 389158 |
Policy instance | 3 |
Insurance contract or identification number | 00 389158 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 113347 |
Policy instance | 2 |
Insurance contract or identification number | LTD 113347 | Number of Individuals Covered | 196 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $552 | Total amount of fees paid to insurance company | USD $346 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,602 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 9 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 83 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $7,448 | Total amount of fees paid to insurance company | USD $126 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 10 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 168 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $18,401 | Total amount of fees paid to insurance company | USD $530 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $84,399 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133903 |
Policy instance | 16 |
Insurance contract or identification number | 1071133903 | Number of Individuals Covered | 1 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $2,854 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000AF12 |
Policy instance | 12 |
Insurance contract or identification number | G000AF12 | Number of Individuals Covered | 418 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $5,047 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $91,868 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL146279 |
Policy instance | 13 |
Insurance contract or identification number | GL146279 | Number of Individuals Covered | 2159 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $4,431 | Total amount of fees paid to insurance company | USD $518 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $213,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 14 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 1129 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $5,008 | Total amount of fees paid to insurance company | USD $260 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $99,437 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133003 |
Policy instance | 15 |
Insurance contract or identification number | 1071133003 | Number of Individuals Covered | 89 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $12,112 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $302,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3331606 |
Policy instance | 17 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 1884 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $41,046 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,038,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NBD5B |
Policy instance | 18 |
Insurance contract or identification number | NBD5B | Number of Individuals Covered | 2 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $91 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $715 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL 135430 |
Policy instance | 1 |
Insurance contract or identification number | GL 135430 | Number of Individuals Covered | 520 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $509 | Total amount of fees paid to insurance company | USD $630 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $13,736 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1133903 |
Policy instance | 20 |
Insurance contract or identification number | 1133903 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 113347 |
Policy instance | 5 |
Insurance contract or identification number | LTD 113347 | Number of Individuals Covered | 198 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $1,843 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL 146279 |
Policy instance | 1 |
Insurance contract or identification number | GL 146279 | Number of Individuals Covered | 1760 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $1,411 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $14,788 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 119978 |
Policy instance | 2 |
Insurance contract or identification number | LTD 119978 | Number of Individuals Covered | 1158 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $1,113 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,417 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 44093 |
Policy instance | 3 |
Insurance contract or identification number | 44093 | Number of Individuals Covered | 1795 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $30,653 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | BASIC AD & D | Welfare Benefit Premiums Paid to Carrier | USD $255,983 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL 135430 |
Policy instance | 4 |
Insurance contract or identification number | GL 135430 | Number of Individuals Covered | 516 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $2,043 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1133003 |
Policy instance | 19 |
Insurance contract or identification number | 1133003 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000815K |
Policy instance | 18 |
Insurance contract or identification number | G000815K | Number of Individuals Covered | 224 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-01-01 | Total amount of commissions paid to insurance broker | USD $4,131 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $55,245 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3331606 |
Policy instance | 17 |
Insurance contract or identification number | 3331606 | Number of Individuals Covered | 1786 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $9,922 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $250,929 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
Policy contract number | 386013 |
Policy instance | 15 |
Insurance contract or identification number | 386013 | Number of Individuals Covered | 1624 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $212,777 | Total amount of fees paid to insurance company | USD $158,221 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $7,911,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 386013 |
Policy instance | 14 |
Insurance contract or identification number | 386013 | Number of Individuals Covered | 1624 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $68 | Total amount of fees paid to insurance company | USD $54 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $2,712 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 13 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 198 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $20,677 | Total amount of fees paid to insurance company | USD $432 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,173 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 12 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 37 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $4,301 | Total amount of fees paid to insurance company | USD $301 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,933 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | AN6683 |
Policy instance | 11 |
Insurance contract or identification number | AN6683 | Number of Individuals Covered | 409 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $67,456 | Total amount of fees paid to insurance company | USD $33,728 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,841,651 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 002 |
Policy instance | 10 |
Insurance contract or identification number | 1071133 002 | Number of Individuals Covered | 9 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $458 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 000 |
Policy instance | 9 |
Insurance contract or identification number | 1071133 000 | Number of Individuals Covered | 1182 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $133,711 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,338,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00 389158 |
Policy instance | 6 |
Insurance contract or identification number | 00 389158 | Number of Individuals Covered | 29 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $1,958 | Total amount of fees paid to insurance company | USD $1,026 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,914 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 001 |
Policy instance | 8 |
Insurance contract or identification number | 1071133 001 | Number of Individuals Covered | 15 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $1,755 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,867 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133 900 |
Policy instance | 7 |
Insurance contract or identification number | 1071133 900 | Number of Individuals Covered | 3 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,841 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133900 |
Policy instance | 9 |
Insurance contract or identification number | 1071133900 | Number of Individuals Covered | 4 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $15,058 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | 146279 |
Policy instance | 12 |
Insurance contract or identification number | 146279 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | AD & D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | NR985 |
Policy instance | 18 |
Insurance contract or identification number | NR985 | Number of Individuals Covered | 32 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $8,875 | Total amount of fees paid to insurance company | USD $117 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,927 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N6472 |
Policy instance | 17 |
Insurance contract or identification number | N6472 | Number of Individuals Covered | 181 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $16,282 | Total amount of fees paid to insurance company | USD $216 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,987 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1133903 |
Policy instance | 16 |
Insurance contract or identification number | 1133903 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 44093 |
Policy instance | 1 |
Insurance contract or identification number | 44093 | Number of Individuals Covered | 1749 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $29,915 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $299,145 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL 135430 |
Policy instance | 2 |
Insurance contract or identification number | GL 135430 | Number of Individuals Covered | 254 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $1,225 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $15,887 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 113347 |
Policy instance | 3 |
Insurance contract or identification number | LTD 113347 | Number of Individuals Covered | 137 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $1,543 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 386013 |
Policy instance | 5 |
Insurance contract or identification number | 386013 | Number of Individuals Covered | 1343 | Insurance policy start date | 2007-03-15 | Insurance policy end date | 2008-03-14 | Total amount of commissions paid to insurance broker | USD $10,804 | Total amount of fees paid to insurance company | USD $7,884 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $392,027 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
Policy contract number | 386013 |
Policy instance | 6 |
Insurance contract or identification number | 386013 | Number of Individuals Covered | 1343 | Insurance policy start date | 2007-03-15 | Insurance policy end date | 2008-03-14 | Total amount of commissions paid to insurance broker | USD $159,059 | Total amount of fees paid to insurance company | USD $116,006 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $5,803,455 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133000 |
Policy instance | 7 |
Insurance contract or identification number | 1071133000 | Number of Individuals Covered | 1196 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $119,305 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $2,982,691 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133001 |
Policy instance | 8 |
Insurance contract or identification number | 1071133001 | Number of Individuals Covered | 5 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $696 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Welfare Benefit Premiums Paid to Carrier | USD $17,067 | 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 number | 00 389158 |
Policy instance | 4 |
Insurance contract or identification number | 00 389158 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $1,943 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,662 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1133003 |
Policy instance | 15 |
Insurance contract or identification number | 1133003 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1133002 |
Policy instance | 14 |
Insurance contract or identification number | 1133002 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | COMPREHENSIVE MEDICAL AND SURGICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | 119978 |
Policy instance | 13 |
Insurance contract or identification number | 119978 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | G000815K |
Policy instance | 10 |
Insurance contract or identification number | G000815K | Number of Individuals Covered | 150 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $3,602 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,043 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010073975 |
Policy instance | 2 |
Insurance contract or identification number | 000010073975 | Number of Individuals Covered | 63 | Insurance policy start date | 2006-01-01 | Insurance policy end date | 2006-12-31 | Total amount of commissions paid to insurance broker | USD $2,024 | Total amount of fees paid to insurance company | USD $1,059 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,175 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133-001 |
Policy instance | 7 |
Insurance contract or identification number | 1071133-001 | Number of Individuals Covered | 1 | Insurance policy start date | 2005-04-01 | Insurance policy end date | 2006-03-31 | Total amount of commissions paid to insurance broker | USD $505 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $13,123 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133-900 |
Policy instance | 6 |
Insurance contract or identification number | 1071133-900 | Number of Individuals Covered | 5 | Insurance policy start date | 2005-04-01 | Insurance policy end date | 2006-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $4,228 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | LTD 113347 |
Policy instance | 5 |
Insurance contract or identification number | LTD 113347 | Number of Individuals Covered | 64 | Insurance policy start date | 2006-01-01 | Insurance policy end date | 2006-12-31 | Total amount of commissions paid to insurance broker | USD $1,169 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,740 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
Policy contract number | GL135430 |
Policy instance | 4 |
Insurance contract or identification number | GL135430 | Number of Individuals Covered | 138 | Insurance policy start date | 2006-01-01 | Insurance policy end date | 2006-12-31 | Total amount of commissions paid to insurance broker | USD $707 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $7,536 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 44093 |
Policy instance | 3 |
Insurance contract or identification number | 44093 | Number of Individuals Covered | 1514 | Insurance policy start date | 2006-01-01 | Insurance policy end date | 2006-12-31 | Total amount of commissions paid to insurance broker | USD $27,707 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $277,069 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
Policy contract number | 1071133-000 |
Policy instance | 8 |
Insurance contract or identification number | 1071133-000 | Number of Individuals Covered | 803 | Insurance policy start date | 2005-04-01 | Insurance policy end date | 2006-03-31 | Total amount of commissions paid to insurance broker | USD $107,711 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $2,703,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|