C AND J CLARK AMERICA INCORPORATED has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan C AND J CLARK, INC. GROUP WELFARE PLAN
401k plan membership statisitcs for C AND J CLARK, INC. GROUP WELFARE PLAN
Measure | Date | Value |
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2022: C AND J CLARK, INC. GROUP WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 600 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 621 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 621 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: C AND J CLARK, INC. GROUP WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 792 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 600 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 600 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: C AND J CLARK, INC. GROUP WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 1,024 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 792 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 792 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: C AND J CLARK, INC. GROUP WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 1,188 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,024 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 27 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 49 |
Total of all active and inactive participants | 2019-01-01 | 1,100 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: C AND J CLARK, INC. GROUP WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 1,500 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,370 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 1,370 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: C AND J CLARK, INC. GROUP WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 1,745 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,449 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 51 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 1,500 |
2016: C AND J CLARK, INC. GROUP WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 1,859 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,745 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 1,745 |
2015: C AND J CLARK, INC. GROUP WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 3,260 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 3,310 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 3,310 |
2014: C AND J CLARK, INC. GROUP WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 3,260 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 3,310 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 3,310 |
2013: C AND J CLARK, INC. GROUP WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 1,775 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,982 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 1,982 |
2012: C AND J CLARK, INC. GROUP WELFARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 1,777 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,775 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
Total of all active and inactive participants | 2012-01-01 | 1,775 |
Total participants | 2012-01-01 | 1,775 |
2011: C AND J CLARK, INC. GROUP WELFARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 1,586 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,777 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
Total of all active and inactive participants | 2011-01-01 | 1,777 |
Total participants | 2011-01-01 | 1,777 |
2009: C AND J CLARK, INC. GROUP WELFARE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 1,316 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,248 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
Total of all active and inactive participants | 2009-01-01 | 1,248 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
Total participants | 2009-01-01 | 1,248 |
2022: C AND J CLARK, INC. GROUP WELFARE PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: C AND J CLARK, INC. GROUP WELFARE PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: C AND J CLARK, INC. GROUP WELFARE PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: C AND J CLARK, INC. GROUP WELFARE PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: C AND J CLARK, INC. GROUP WELFARE PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: C AND J CLARK, INC. GROUP WELFARE PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Submission has been amended | No |
2017-01-01 | This submission is the final filing | No |
2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-01-01 | Plan is a collectively bargained plan | No |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: C AND J CLARK, INC. GROUP WELFARE PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Submission has been amended | No |
2016-01-01 | This submission is the final filing | No |
2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-01-01 | Plan is a collectively bargained plan | No |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: C AND J CLARK, INC. GROUP WELFARE PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Submission has been amended | No |
2015-01-01 | This submission is the final filing | No |
2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-01-01 | Plan is a collectively bargained plan | No |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: C AND J CLARK, INC. GROUP WELFARE PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Submission has been amended | No |
2014-01-01 | This submission is the final filing | No |
2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-01-01 | Plan is a collectively bargained plan | No |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: C AND J CLARK, INC. GROUP WELFARE PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Submission has been amended | No |
2013-01-01 | This submission is the final filing | No |
2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-01-01 | Plan is a collectively bargained plan | No |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2012: C AND J CLARK, INC. GROUP WELFARE PLAN 2012 form 5500 responses |
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2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Submission has been amended | No |
2012-01-01 | This submission is the final filing | No |
2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-01-01 | Plan is a collectively bargained plan | No |
2012-01-01 | Plan funding arrangement – Insurance | Yes |
2012-01-01 | Plan benefit arrangement – Insurance | Yes |
2011: C AND J CLARK, INC. GROUP WELFARE PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | First time form 5500 has been submitted | Yes |
2011-01-01 | Submission has been amended | No |
2011-01-01 | This submission is the final filing | No |
2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-01-01 | Plan is a collectively bargained plan | No |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2009: C AND J CLARK, INC. GROUP WELFARE PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | First time form 5500 has been submitted | Yes |
2009-01-01 | Submission has been amended | No |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-01-01 | Plan is a collectively bargained plan | No |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30077979 |
Policy instance | 1 |
Insurance contract or identification number | 30077979 | Number of Individuals Covered | 597 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,272 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 947866 |
Policy instance | 2 |
Insurance contract or identification number | 947866 | Number of Individuals Covered | 806 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $13,509 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $366,519 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,509 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968565 |
Policy instance | 2 |
Insurance contract or identification number | FLX968565 | Number of Individuals Covered | 600 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $136,271 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30077979 |
Policy instance | 1 |
Insurance contract or identification number | 30077979 | Number of Individuals Covered | 600 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $61,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968565 |
Policy instance | 2 |
Insurance contract or identification number | FLX968565 | Number of Individuals Covered | 792 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $447,243 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30077979 |
Policy instance | 1 |
Insurance contract or identification number | 30077979 | Number of Individuals Covered | 792 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $81,244 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX968565 |
Policy instance | 2 |
Insurance contract or identification number | FLX968565 | Number of Individuals Covered | 1163 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,670 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $264,758 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,670 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30077979 |
Policy instance | 1 |
Insurance contract or identification number | 30077979 | Number of Individuals Covered | 968 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $94,699 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30077979 |
Policy instance | 1 |
Insurance contract or identification number | 30077979 | Number of Individuals Covered | 1036 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $98,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 2 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1370 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $453,178 | 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 | 23997 |
Policy instance | 1 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1447 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL 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 Carrier | USD $506,030 | 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 | 23997 |
Policy instance | 1 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1859 | 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 $187 | 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 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL 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 Carrier | USD $577,290 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 92 | Additional information about fees paid to insurance broker | PRINTING SERVICES | Insurance broker organization code? | 5 | Insurance broker name | HARVARD PRINTING GROUP |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 1 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1997 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $44,260 | Total amount of fees paid to insurance company | USD $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 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL 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 Carrier | USD $884,010 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $44,260 | Insurance broker organization code? | 3 | Insurance broker name | SAVITZ ORGANIZATION, INC. |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 9 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 5 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | Other welfare benefits provided | HAWAII TDI | 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 $1,094 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 5 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | VOLUNTARY DEP LIFE CHILD | 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 $572 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 8 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1982 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 $398,887 | 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 | 23997 |
Policy instance | 7 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1977 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | BASIC AD&D INSURANCE | 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 $37,486 | 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 | 23997 |
Policy instance | 6 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1977 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | 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 $168,911 | 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 | 23997 |
Policy instance | 4 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | VOLUNTARY DEPENDENT LIFE SPOUSE/FAM | 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 $7,530 | 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 | 23997 |
Policy instance | 3 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 446 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | 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 $180,482 | 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 | 23997 |
Policy instance | 2 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 446 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $36,138 | Total amount of fees paid to insurance company | USD $2,858 | 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 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 | 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 $188,584 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,138 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | HARVARD PRINTING GROUP |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 2472802,3212676 |
Policy instance | 1 |
Insurance contract or identification number | 2472802,3212676 | Number of Individuals Covered | 3260 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 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 | 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 $3,648,729 | 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 | 23997 |
Policy instance | 8 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 2 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | HAWAII TDI | Welfare Benefit Premiums Paid to Carrier | USD $732 | 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 | 23997 |
Policy instance | 1 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 453 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $35,221 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $187,553 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,221 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | THE SAVITZ ORGANIZATION INC |
|
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 0020050000 |
Policy instance | 10 |
Insurance contract or identification number | 0020050000 | Number of Individuals Covered | 3152 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | 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 | 2472802,3212676 |
Policy instance | 9 |
Insurance contract or identification number | 2472802,3212676 | Number of Individuals Covered | 3145 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,010,239 | 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 | 23997 |
Policy instance | 7 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1898 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $432,531 | 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 | 23997 |
Policy instance | 6 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1896 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BASIC AD&D INSURANCE | Welfare Benefit Premiums Paid to Carrier | USD $38,586 | 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 | 23997 |
Policy instance | 5 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1896 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $192,932 | 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 | 23997 |
Policy instance | 4 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY DEP LIFE CHILD | Welfare Benefit Premiums Paid to Carrier | USD $578 | 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 | 23997 |
Policy instance | 3 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY DEPENDENT LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $8,061 | 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 | 23997 |
Policy instance | 2 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 453 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,914 | 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 | 23997 |
Policy instance | 8 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1782 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $608,399 | 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 | 23997 |
Policy instance | 9 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1777 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $176,387 | 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 | 23997 |
Policy instance | 10 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1777 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | BASIC AD&D INSURANCE | Welfare Benefit Premiums Paid to Carrier | USD $35,278 | 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 | 23997 |
Policy instance | 11 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1782 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $395,745 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
CERIDIAN CORPORATION (National Association of Insurance Commissioners NAIC id number: 54121 ) |
Policy contract number | 17050 |
Policy instance | 13 |
Insurance contract or identification number | 17050 | Number of Individuals Covered | 1000 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $32,886 | 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 | 247802, 321676 |
Policy instance | 14 |
Insurance contract or identification number | 247802, 321676 | Number of Individuals Covered | 2975 | 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 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,516,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 002005 |
Policy instance | 15 |
Insurance contract or identification number | 002005 | Number of Individuals Covered | 2859 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Dental Insurance Welfare Benefit | Yes | 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 | 23997 |
Policy instance | 3 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | VOLUNTARY DEPENDENT LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $7,893 | 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 | 23997 |
Policy instance | 7 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | BASIC DEP LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $0 | 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 | 23997 |
Policy instance | 6 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | BASIC DEP LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $0 | 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 | 23997 |
Policy instance | 12 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 5 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | HAWAII TDI | Welfare Benefit Premiums Paid to Carrier | USD $991 | 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 | 23997 |
Policy instance | 1 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 453 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $38,575 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $164,082 | 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 | 23997 |
Policy instance | 2 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 453 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,679 | 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 | 23997 |
Policy instance | 4 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | VOLUNTARY DEP LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $7,893 | 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 | 23997 |
Policy instance | 5 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Other welfare benefits provided | VOLUNTARY DEP LIFE CHILD | Welfare Benefit Premiums Paid to Carrier | USD $510 | 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 | 23997 |
Policy instance | 3 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 426 | 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 | Other welfare benefits provided | VOLUNTARY LIFE INSURANCE | Welfare Benefit Premiums Paid to Carrier | USD $147,482 | 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 name | |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 4 |
Insurance contract or identification number | 23997 | 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 | Other welfare benefits provided | VOL DEP LIFE SPOUSE/FAM | Welfare Benefit Premiums Paid to Carrier | USD $7,437 | Commission paid to Insurance Broker | USD $0 | Insurance broker name | |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 5 |
Insurance contract or identification number | 23997 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Other welfare benefits provided | VOL LIFE DEP CHILD | Welfare Benefit Premiums Paid to Carrier | USD $430 | 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 | 23997 |
Policy instance | 6 |
Insurance contract or identification number | 23997 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | 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 | 23997 |
Policy instance | 7 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1586 | 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 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $541,155 | 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 | 23997 |
Policy instance | 8 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1579 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $156,798 | 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 | 23997 |
Policy instance | 9 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1579 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Other welfare benefits provided | BASIC AD&D INSURANCE | Welfare Benefit Premiums Paid to Carrier | USD $31,360 | 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 | 23997 |
Policy instance | 10 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1586 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $351,938 | 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 | 23997 |
Policy instance | 2 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 426 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,439 | 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 name | |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 12 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 1586 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $34,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $34,772 | Insurance broker organization code? | 3 | Insurance broker name | THE SAVITZ ORGANIZATION |
|
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 002005 |
Policy instance | 13 |
Insurance contract or identification number | 002005 | Number of Individuals Covered | 2469 | 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 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CERIDIAN CORPORATION (National Association of Insurance Commissioners NAIC id number: 54121 ) |
Policy contract number | 17050 |
Policy instance | 14 |
Insurance contract or identification number | 17050 | Number of Individuals Covered | 1030 | 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 | Health Insurance Welfare Benefit | No | Other welfare benefits provided | EAP | Welfare Benefit Premiums Paid to Carrier | USD $26,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 2472802 3212676 |
Policy instance | 1 |
Insurance contract or identification number | 2472802 3212676 | Number of Individuals Covered | 2597 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,006,515 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 23997 |
Policy instance | 11 |
Insurance contract or identification number | 23997 | Number of Individuals Covered | 7 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,058 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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