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LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 401k Plan overview

Plan NameLONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC
Plan identification number 501

LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

WISCONSIN COMMUNITY SERVICES INC has sponsored the creation of one or more 401k plans.

Company Name:WISCONSIN COMMUNITY SERVICES INC
Employer identification number (EIN):390808464
NAIC Classification:624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01LORI SHEETS LORI SHEETS2018-10-12
5012017-01-01LORI SHEETS LORI SHEETS2018-10-12
5012016-01-01LORI SHEETS
5012015-01-01LORI SHEETS LORI SHEETS2016-10-14
5012014-01-01LORI SHEETS
5012014-01-01LORI SHEETS
5012013-01-01LORI SHEETS LORI SHEETS2014-10-14
5012012-01-01LORI SHEETS
5012010-01-01LORI SHEETS

Plan Statistics for LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC

401k plan membership statisitcs for LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC

Measure Date Value
2022: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2022 401k membership
Total participants, beginning-of-year2022-01-01380
Total number of active participants reported on line 7a of the Form 55002022-01-01401
Total of all active and inactive participants2022-01-01401
Total participants2022-01-01401
2021: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2021 401k membership
Total participants, beginning-of-year2021-01-01362
Total number of active participants reported on line 7a of the Form 55002021-01-01381
Total of all active and inactive participants2021-01-01381
Total participants2021-01-01381
2020: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2020 401k membership
Total participants, beginning-of-year2020-01-01307
Total number of active participants reported on line 7a of the Form 55002020-01-01362
Total of all active and inactive participants2020-01-01362
Total participants2020-01-01362
2019: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2019 401k membership
Total participants, beginning-of-year2019-01-01228
Total number of active participants reported on line 7a of the Form 55002019-01-01283
Total of all active and inactive participants2019-01-01283
Total participants2019-01-01283
2018: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2018 401k membership
Total participants, beginning-of-year2018-01-01229
Total number of active participants reported on line 7a of the Form 55002018-01-01231
Number of retired or separated participants receiving benefits2018-01-011
Total of all active and inactive participants2018-01-01232
Total participants2018-01-01232
2017: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2017 401k membership
Total participants, beginning-of-year2017-01-01193
Total number of active participants reported on line 7a of the Form 55002017-01-01229
Total of all active and inactive participants2017-01-01229
Total participants2017-01-01229
2016: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2016 401k membership
Total participants, beginning-of-year2016-01-01218
Total number of active participants reported on line 7a of the Form 55002016-01-01193
Total of all active and inactive participants2016-01-01193
Total participants2016-01-01193
2015: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2015 401k membership
Total participants, beginning-of-year2015-01-01212
Total number of active participants reported on line 7a of the Form 55002015-01-01218
Total of all active and inactive participants2015-01-01218
Total participants2015-01-01218
2014: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2014 401k membership
Total participants, beginning-of-year2014-01-01213
Total of all active and inactive participants2014-01-010
Total participants2014-01-010
2013: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2013 401k membership
Total participants, beginning-of-year2013-01-01231
Total number of active participants reported on line 7a of the Form 55002013-01-01213
Total of all active and inactive participants2013-01-01213
Total participants2013-01-01213
2012: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2012 401k membership
Total participants, beginning-of-year2012-01-01225
Total number of active participants reported on line 7a of the Form 55002012-01-01231
Total of all active and inactive participants2012-01-01231
Total participants2012-01-01231
2010: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2010 401k membership
Total participants, beginning-of-year2010-01-01204
Total number of active participants reported on line 7a of the Form 55002010-01-01197
Total of all active and inactive participants2010-01-01197
Total participants2010-01-01197

Form 5500 Responses for LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC

2022: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2010: LONG TERM DISABILITY PLAN OF WISCONSIN COMMUNITY SERVICES INC 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered401
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,259
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $55,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,259
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerSTANDARD COMMISSIONS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered381
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,327
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $48,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,327
Additional information about fees paid to insurance brokerSTANDARD COMMISSION
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered362
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,862
Total amount of fees paid to insurance companyUSD $115
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $37,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,862
Amount paid for insurance broker fees115
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?7
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered283
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,444
Total amount of fees paid to insurance companyUSD $210
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $28,882
Commission paid to Insurance BrokerUSD $1,310
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?7
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered232
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,393
Total amount of fees paid to insurance companyUSD $392
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $27,859
Commission paid to Insurance BrokerUSD $339
Amount paid for insurance broker fees392
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?7
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered229
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,590
Total amount of fees paid to insurance companyUSD $320
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $28,396
Commission paid to Insurance BrokerUSD $3,590
Amount paid for insurance broker fees320
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?7
Insurance broker nameWILLIS OF WISCONSIN INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSD601075
Policy instance 1
Insurance contract or identification numberSD601075
Number of Individuals Covered218
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $3,128
Total amount of fees paid to insurance companyUSD $196
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 BenefitYes
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 $24,059
Commission paid to Insurance BrokerUSD $3,128
Amount paid for insurance broker fees196
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?7
Insurance broker nameWILLIS OF WISCONSIN INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered212
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,558
Total amount of fees paid to insurance companyUSD $189
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 $25,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,558
Amount paid for insurance broker fees189
Additional information about fees paid to insurance brokerSUPP. COMMISSION AND OVERRIDE
Insurance broker organization code?7
Insurance broker nameWILLIS OF WISCONSIN IN
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered213
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $3,073
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 BenefitYes
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 $23,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,073
Amount paid for insurance broker fees-60
Additional information about fees paid to insurance brokerSALES AND SERVICE SUPP COMMISSION AND OVERRIDE
Insurance broker organization code?7
Insurance broker nameWILLIS OF WISCONSIN INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered231
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,400
Total amount of fees paid to insurance companyUSD $60
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,400
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerSUPP COMMISSION & OVERRIDE
Insurance broker organization code?7
Insurance broker nameWILLIS OF WISCONSIN INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD601075
Policy instance 1
Insurance contract or identification numberSGD601075
Number of Individuals Covered197
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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