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LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 401k Plan overview

Plan NameLIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.
Plan identification number 502

LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BOSCOV'S, INC. has sponsored the creation of one or more 401k plans.

Company Name:BOSCOV'S, INC.
Employer identification number (EIN):231571589
NAIC Classification:448140
NAIC Description:Family Clothing Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01MICHELLE L. DUPELL2022-08-18
5022020-01-01DIETER F. CZERNY2021-08-03
5022019-09-01DIETER F. CZERNY2020-04-21
5022018-09-01DIETER F. CZERNY2020-01-23
5022017-09-01TONI MILLER
5022016-09-01TONI MILLER
5022015-09-01TONI MILLER
5022014-09-01TONI MILLER
5022013-09-01TONI MILLER
5022012-09-01TONI M. MILLER
5022011-09-01TONI M. MILLER
5022010-09-01TONI M. MILLER
5022009-09-01TONI M. MILLER, CFO

Plan Statistics for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

401k plan membership statisitcs for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

Measure Date Value
2021: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-013,566
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
2020: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-014,788
Total number of active participants reported on line 7a of the Form 55002020-01-013,498
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-013,498
2019: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2019 401k membership
Total participants, beginning-of-year2019-09-014,489
Total number of active participants reported on line 7a of the Form 55002019-09-014,728
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-014,728
2018: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2018 401k membership
Total participants, beginning-of-year2018-09-014,702
Total number of active participants reported on line 7a of the Form 55002018-09-014,789
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-014,789
2017: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2017 401k membership
Total participants, beginning-of-year2017-09-014,650
Total number of active participants reported on line 7a of the Form 55002017-09-014,776
Total of all active and inactive participants2017-09-014,776
Total participants2017-09-014,776
2016: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2016 401k membership
Total participants, beginning-of-year2016-09-014,532
Total number of active participants reported on line 7a of the Form 55002016-09-014,650
Total of all active and inactive participants2016-09-014,650
Total participants2016-09-014,650
2015: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2015 401k membership
Total participants, beginning-of-year2015-09-014,694
Total number of active participants reported on line 7a of the Form 55002015-09-014,532
Total of all active and inactive participants2015-09-014,532
Total participants2015-09-014,532
2014: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2014 401k membership
Total participants, beginning-of-year2014-09-014,539
Total number of active participants reported on line 7a of the Form 55002014-09-014,694
Total of all active and inactive participants2014-09-014,694
Total participants2014-09-014,694
2013: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2013 401k membership
Total participants, beginning-of-year2013-09-014,539
Total number of active participants reported on line 7a of the Form 55002013-09-014,539
Total of all active and inactive participants2013-09-014,539
Total participants2013-09-014,539
2012: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2012 401k membership
Total participants, beginning-of-year2012-09-014,518
Total number of active participants reported on line 7a of the Form 55002012-09-014,539
Total of all active and inactive participants2012-09-014,539
Total participants2012-09-014,539
2011: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2011 401k membership
Total participants, beginning-of-year2011-09-014,414
Total number of active participants reported on line 7a of the Form 55002011-09-014,518
Total of all active and inactive participants2011-09-014,518
Total participants2011-09-014,518
2010: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2010 401k membership
Total participants, beginning-of-year2010-09-014,465
Total number of active participants reported on line 7a of the Form 55002010-09-014,414
Total of all active and inactive participants2010-09-014,414
Total participants2010-09-014,414
2009: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2009 401k membership
Total participants, beginning-of-year2009-09-014,343
Total number of active participants reported on line 7a of the Form 55002009-09-014,465
Total of all active and inactive participants2009-09-014,465
Total participants2009-09-014,465

Form 5500 Responses for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

2021: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Submission has been amendedNo
2019-09-01This submission is the final filingNo
2019-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-09-01Plan is a collectively bargained planNo
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Submission has been amendedNo
2018-09-01This submission is the final filingNo
2018-09-01This return/report is a short plan year return/report (less than 12 months)No
2018-09-01Plan is a collectively bargained planNo
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2010: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes
2009: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberSA3-890LF046101
Policy instance 1
Insurance contract or identification numberSA3-890LF046101
Number of Individuals Covered3790
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $21,724
Total amount of fees paid to insurance companyUSD $3,399
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 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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 $310,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,724
Amount paid for insurance broker fees3399
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4882
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,069
Total amount of fees paid to insurance companyUSD $102
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 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 providedACCIDENTAL DEATH AND 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 $53,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,069
Amount paid for insurance broker fees102
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4882
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $48,951
Total amount of fees paid to insurance companyUSD $1,174
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 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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $699,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,951
Amount paid for insurance broker fees1174
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4985
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,373
Total amount of fees paid to insurance companyUSD $1,832
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 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 providedACCIDENTAL DEATH AND 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 $62,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,311
Amount paid for insurance broker fees1832
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4985
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $50,302
Total amount of fees paid to insurance companyUSD $12,000
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 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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $718,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,870
Amount paid for insurance broker fees12000
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4783
Insurance policy start date2018-09-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,990
Total amount of fees paid to insurance companyUSD $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 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 providedACCIDENTAL DEATH AND 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 $19,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,990
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4783
Insurance policy start date2018-09-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $16,048
Total amount of fees paid to insurance companyUSD $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 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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 $229,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,048
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4776
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $9,115
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $60,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4776
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $43,083
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $615,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4532
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $25,905
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $370,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,905
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4532
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $8,493
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $56,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,493
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR204570
Policy instance 2
Insurance contract or identification numberVAR204570
Number of Individuals Covered4694
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $8,158
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $54,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,158
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL145250
Policy instance 1
Insurance contract or identification numberGL145250
Number of Individuals Covered4694
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $19,036
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $271,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,036
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4539
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $8,026
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $53,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,026
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL145250
Policy instance 1
Insurance contract or identification numberGL145250
Number of Individuals Covered4539
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $18,726
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $267,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,726
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4539
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $23,575
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $280,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,575
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4539
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $9,191
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $56,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,191
Insurance broker organization code?3
Insurance broker nameKINLOCH CONSULTING GROUP, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4518
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $8,995
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $50,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4518
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $28,712
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $283,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 204570
Policy instance 2
Insurance contract or identification numberVAR 204570
Number of Individuals Covered4414
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $8,879
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $51,845
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 145250
Policy instance 1
Insurance contract or identification numberGL 145250
Number of Individuals Covered4414
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $30,587
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,230

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