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UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 401k Plan overview

Plan NameUNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT
Plan identification number 505

UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT Benefits

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

401k Sponsoring company profile

MUSKINGUM UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name:MUSKINGUM UNIVERSITY
Employer identification number (EIN):314379515
NAIC Classification:611000

Additional information about MUSKINGUM UNIVERSITY

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1837-03-18
Company Identification Number: 136003
Legal Registered Office Address: 163 STORMONT STREEET
-
NEW CONCORD
United States of America (USA)
43762

More information about MUSKINGUM UNIVERSITY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052019-04-01
5052018-04-01KATHY MOORE PHILIP LAUBE2019-06-10
5052017-04-01KATHY MOORE PHILIP LAUBE2018-06-21
5052016-04-01KATHY MOORE PHILIP LAUBE2017-06-23
5052015-04-01KATHY MOORE PHILIP LAUBE2016-06-23
5052014-04-01KATHY MOORE JAMES WILSON2015-06-30
5052013-04-01JAMES WILSON KATHY MOORE2014-10-10
5052012-04-01KATHY MOORE JAMES WILSON2013-06-13
5052011-04-01KATHY MOORE JAMES WILSON2012-07-02
5052010-04-01KATHY MOORE JAMES WILSON2011-07-07
5052009-01-01JAMES WILSON

Plan Statistics for UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT

401k plan membership statisitcs for UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT

Measure Date Value
2019: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year2019-04-01274
Total number of active participants reported on line 7a of the Form 55002019-04-010
Total of all active and inactive participants2019-04-010
Total participants2019-04-010
2018: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year2018-04-01275
Total number of active participants reported on line 7a of the Form 55002018-04-01268
Total of all active and inactive participants2018-04-01268
Total participants2018-04-01268
Number of employers contributing to the scheme2018-04-010
2017: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year2017-04-01270
Total number of active participants reported on line 7a of the Form 55002017-04-01275
Total of all active and inactive participants2017-04-01275
Total participants2017-04-01275
Number of employers contributing to the scheme2017-04-010
2016: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year2016-04-01265
Total number of active participants reported on line 7a of the Form 55002016-04-01270
Total of all active and inactive participants2016-04-01270
Total participants2016-04-01270
Number of employers contributing to the scheme2016-04-010
2015: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year2015-04-01266
Total number of active participants reported on line 7a of the Form 55002015-04-01265
Total of all active and inactive participants2015-04-01265
Total participants2015-04-01265
Number of employers contributing to the scheme2015-04-010
2014: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year2014-04-01273
Total number of active participants reported on line 7a of the Form 55002014-04-01266
Total of all active and inactive participants2014-04-01266
Total participants2014-04-01266
2013: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year2013-04-01279
Total number of active participants reported on line 7a of the Form 55002013-04-01273
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01273
Total participants2013-04-01273
Number of participants with account balances2013-04-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-04-010
2012: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year2012-04-01279
Total number of active participants reported on line 7a of the Form 55002012-04-01273
Total of all active and inactive participants2012-04-01273
Total participants2012-04-01273
2011: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year2011-04-01279
Total number of active participants reported on line 7a of the Form 55002011-04-01279
Total of all active and inactive participants2011-04-01279
Total participants2011-04-01279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-04-010
Number of employers contributing to the scheme2011-04-010
2010: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2010 401k membership
Total participants, beginning-of-year2010-04-01291
Total number of active participants reported on line 7a of the Form 55002010-04-01284
Total of all active and inactive participants2010-04-01284
Total participants2010-04-01284
2009: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year2009-01-01291
Total number of active participants reported on line 7a of the Form 55002009-01-01291
Total of all active and inactive participants2009-01-01291
Total participants2009-01-01291
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Form 5500 Responses for UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT

2019: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingYes
2019-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01First time form 5500 has been submittedYes
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01First time form 5500 has been submittedYes
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01First time form 5500 has been submittedYes
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01First time form 5500 has been submittedYes
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01First time form 5500 has been submittedYes
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01First time form 5500 has been submittedYes
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01First time form 5500 has been submittedYes
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01First time form 5500 has been submittedYes
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01First time form 5500 has been submittedYes
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: UNUM LIFE INSURANCE CO LIFE INSURANCE AND ACIDENTAL DEATH AND DISMEMBERMENT 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered273
Insurance policy start date2019-04-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $2,713
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 $24,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered268
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $3,282
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 $32,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,282
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered275
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $3,553
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 $35,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,553
Insurance broker nameTHE FORKER COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered265
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $3,376
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare 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 $30,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,376
Insurance broker nameTHE FORKER COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered266
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $3,423
Total amount of fees paid to insurance companyUSD $34,148
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare 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 $34,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,423
Amount paid for insurance broker fees34148
Insurance broker nameTHE FORKER COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered273
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $3,399
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $34,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,399
Insurance broker nameTHE FORKER AGENCY INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered273
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $3,409
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,068
Insurance broker nameTHE FORKER COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered279
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $3,671
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $39,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number121004
Policy instance 1
Insurance contract or identification number121004
Number of Individuals Covered284
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $2,889
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameTHE FORKER AGENCY INC

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