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THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 401k Plan overview

Plan NameTHE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN
Plan identification number 503

THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

XO GROUP INC. has sponsored the creation of one or more 401k plans.

Company Name:XO GROUP INC.
Employer identification number (EIN):133895178
NAIC Classification:541519
NAIC Description:Other Computer Related Services

Additional information about XO GROUP INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2005-02-07
Company Identification Number: 0800451407
Legal Registered Office Address: 2 WISCONSIN CIR STE 300

CHEVY CHASE
United States of America (USA)
20815

More information about XO GROUP INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032014-01-01JANET RUBIN
5032013-01-01JANET RUBIN
5032012-01-01JANET RUBIN
5032011-01-01JANET RUBIN JANET RUBIN2016-06-17
5032010-01-01JANET RUBIN JANET RUBIN2016-06-17
5032009-01-01JANET RUBIN JANET RUBIN2016-06-17
5032008-01-01JANET RUBIN JANET RUBIN2016-06-17
5032007-01-01JANET RUBIN JANET RUBIN2016-06-17
5032006-01-01JANET RUBIN JANET RUBIN2016-06-17

Plan Statistics for THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN

401k plan membership statisitcs for THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN

Measure Date Value
2014: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01515
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-010
2013: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01524
Total number of active participants reported on line 7a of the Form 55002013-01-01515
Total of all active and inactive participants2013-01-01515
2012: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01501
Total number of active participants reported on line 7a of the Form 55002012-01-01524
Total of all active and inactive participants2012-01-01524
2011: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01510
Total number of active participants reported on line 7a of the Form 55002011-01-01501
Total of all active and inactive participants2011-01-01501
Total participants2011-01-01501
2010: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01504
Total number of active participants reported on line 7a of the Form 55002010-01-01510
Total of all active and inactive participants2010-01-01510
Total participants2010-01-01510
2009: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01481
Total number of active participants reported on line 7a of the Form 55002009-01-01217
Total of all active and inactive participants2009-01-01217
Total participants2009-01-01217
2008: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01470
Total number of active participants reported on line 7a of the Form 55002008-01-01481
Total of all active and inactive participants2008-01-01481
Total participants2008-01-01481
2007: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01368
Total number of active participants reported on line 7a of the Form 55002007-01-01470
Total of all active and inactive participants2007-01-01470
Total participants2007-01-01470
2006: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01359
Total number of active participants reported on line 7a of the Form 55002006-01-01368
Total of all active and inactive participants2006-01-01368
Total participants2006-01-01368

Form 5500 Responses for THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN

2014: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01This submission is the final filingYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: THE KNOT, INC. LIFE INSURANCE SHORT TERM DISABILITY AND LONG TERM DISABILITY PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137336
Policy instance 1
Insurance contract or identification number137336
Number of Individuals Covered542
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $19,737
Total amount of fees paid to insurance companyUSD $3,947
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $197,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,737
Amount paid for insurance broker fees3947
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number6550010
Policy instance 4
Insurance contract or identification number6550010
Number of Individuals Covered24
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $608
Total amount of fees paid to insurance companyUSD $44
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $5,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Amount paid for insurance broker fees44
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number143660
Policy instance 3
Insurance contract or identification number143660
Number of Individuals Covered284
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,291
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $13,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,291
Insurance broker organization code?3
Insurance broker nameSHANE JACOBSEN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137113
Policy instance 2
Insurance contract or identification number137113
Number of Individuals Covered110
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,118
Total amount of fees paid to insurance companyUSD $624
Other welfare benefits providedLIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,118
Amount paid for insurance broker fees624
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137336
Policy instance 1
Insurance contract or identification number137336
Number of Individuals Covered515
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,809
Total amount of fees paid to insurance companyUSD $3,362
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $178,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,809
Amount paid for insurance broker fees3362
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137113
Policy instance 2
Insurance contract or identification number137113
Number of Individuals Covered98
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,697
Total amount of fees paid to insurance companyUSD $539
Other welfare benefits providedLIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $27,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,697
Amount paid for insurance broker fees539
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number143660
Policy instance 3
Insurance contract or identification number143660
Number of Individuals Covered284
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $962
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $9,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $962
Insurance broker organization code?3
Insurance broker nameSHANE JACOBSEN
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number6550010
Policy instance 4
Insurance contract or identification number6550010
Number of Individuals Covered33
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $811
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $8,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $811
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137336
Policy instance 1
Insurance contract or identification number137336
Number of Individuals Covered524
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,505
Total amount of fees paid to insurance companyUSD $570
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $165,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,654
Insurance broker organization code?3
Amount paid for insurance broker fees570
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameLOCKTON COMPANIES, LLC
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number6550010
Policy instance 4
Insurance contract or identification number6550010
Number of Individuals Covered46
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,133
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $11,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,133
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number143660
Policy instance 3
Insurance contract or identification number143660
Number of Individuals Covered284
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $863
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $9,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $863
Insurance broker organization code?3
Insurance broker nameSHANE JACOBSEN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137113
Policy instance 2
Insurance contract or identification number137113
Number of Individuals Covered98
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,144
Total amount of fees paid to insurance companyUSD $70
Other welfare benefits providedLIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,796
Insurance broker organization code?3
Amount paid for insurance broker fees70
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameLOCKTON COMPANIES, LLC
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number6550010
Policy instance 4
Insurance contract or identification number6550010
Number of Individuals Covered47
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,096
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLEGAL
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 CarrierUSD $10,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,096
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number143660
Policy instance 3
Insurance contract or identification number143660
Number of Individuals Covered284
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $836
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSTATUTORY DISABILITY
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 CarrierUSD $8,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $836
Insurance broker organization code?3
Insurance broker nameSHANE JACOBSEN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137113
Policy instance 2
Insurance contract or identification number137113
Number of Individuals Covered98
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,204
Total amount of fees paid to insurance companyUSD $165
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLIFESTYLE LIFE AND 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 CarrierUSD $22,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,204
Amount paid for insurance broker fees165
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137336
Policy instance 1
Insurance contract or identification number137336
Number of Individuals Covered501
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,390
Total amount of fees paid to insurance companyUSD $1,154
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $153,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,390
Amount paid for insurance broker fees1154
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137336
Policy instance 1
Insurance contract or identification number137336
Number of Individuals Covered510
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,759
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,759
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number137113
Policy instance 2
Insurance contract or identification number137113
Number of Individuals Covered98
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,510
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLIFESTYLE LIFE AND 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 CarrierUSD $25,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,510
Insurance broker organization code?3
Insurance broker nameNP DODGE INSURANCE AGENCY, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302174
Policy instance 1
Insurance contract or identification number302174
Number of Individuals Covered217
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSUPPLEMENTAL 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 CarrierUSD $188,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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