BURGESS HEALTH CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN
Measure | Date | Value |
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2022: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 191 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 207 |
Total of all active and inactive participants | 2022-01-01 | 207 |
2021: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 190 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 191 |
Total of all active and inactive participants | 2021-01-01 | 191 |
2020: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 191 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 190 |
Total of all active and inactive participants | 2020-01-01 | 190 |
2019: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 192 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 191 |
Total of all active and inactive participants | 2019-01-01 | 191 |
2018: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 196 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 192 |
Total of all active and inactive participants | 2018-01-01 | 192 |
2017: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 208 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 196 |
Total of all active and inactive participants | 2017-01-01 | 196 |
2016: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 185 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 208 |
Total of all active and inactive participants | 2016-01-01 | 208 |
2015: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 181 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 185 |
Total of all active and inactive participants | 2015-01-01 | 185 |
2014: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 169 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 181 |
Total of all active and inactive participants | 2014-01-01 | 181 |
2013: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 169 |
Total of all active and inactive participants | 2013-01-01 | 169 |
2012: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 172 |
Total of all active and inactive participants | 2012-01-01 | 172 |
2011: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 168 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 172 |
Total of all active and inactive participants | 2011-01-01 | 172 |
2010: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 152 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 168 |
Total of all active and inactive participants | 2010-01-01 | 168 |
2009: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 147 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 152 |
Total of all active and inactive participants | 2009-01-01 | 152 |
2022: EMPLOYEES GROUP LIFE AND AD&D INSURANCE 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 benefit arrangement – Insurance | Yes |
2021: EMPLOYEES GROUP LIFE AND AD&D INSURANCE 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 benefit arrangement – Insurance | Yes |
2020: EMPLOYEES GROUP LIFE AND AD&D INSURANCE 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 benefit arrangement – Insurance | Yes |
2019: EMPLOYEES GROUP LIFE AND AD&D INSURANCE 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 benefit arrangement – Insurance | Yes |
2018: EMPLOYEES GROUP LIFE AND AD&D INSURANCE 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 benefit arrangement – Insurance | Yes |
2017: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2016: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2015: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2014: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2013: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2012: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2012 form 5500 responses |
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2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Plan funding arrangement – Insurance | Yes |
2012-01-01 | Plan benefit arrangement – Insurance | Yes |
2011: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2010: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2010 form 5500 responses |
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2010-01-01 | Type of plan entity | Single employer plan |
2010-01-01 | Plan funding arrangement – Insurance | Yes |
2010-01-01 | Plan benefit arrangement – Insurance | Yes |
2009: EMPLOYEES GROUP LIFE AND AD&D INSURANCE PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018243-00 |
Policy instance | 1 |
Insurance contract or identification number | 01-018243-00 | Number of Individuals Covered | 207 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $5,745 | Total amount of fees paid to insurance company | USD $15,425 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $19,569 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,745 | Amount paid for insurance broker fees | 15425 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018243-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-018243-00 | Number of Individuals Covered | 191 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $180 | Total amount of fees paid to insurance company | USD $88 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $180 | Amount paid for insurance broker fees | 88 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018243-00 |
Policy instance | 1 |
Insurance contract or identification number | 01-018243-00 | Number of Individuals Covered | 191 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,882 | Total amount of fees paid to insurance company | USD $916 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,818 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,882 | Amount paid for insurance broker fees | 916 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 803497G |
Policy instance | 1 |
Insurance contract or identification number | 803497G | Number of Individuals Covered | 188 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,875 | Total amount of fees paid to insurance company | USD $1,259 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,332 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,875 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1259 | Additional information about fees paid to insurance broker | OTHER FEES |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018243-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-018243-00 | Number of Individuals Covered | 190 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,305 | Total amount of fees paid to insurance company | USD $327 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,047 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,305 | Amount paid for insurance broker fees | 327 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-018243-00 |
Policy instance | 3 |
Insurance contract or identification number | 01-018243-00 | Number of Individuals Covered | 190 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $124 | Total amount of fees paid to insurance company | USD $31 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,239 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $124 | Amount paid for insurance broker fees | 31 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 803497G |
Policy instance | 2 |
Insurance contract or identification number | 803497G | Number of Individuals Covered | 191 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,243 | Total amount of fees paid to insurance company | USD $15 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $10,201 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,243 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 15 | Additional information about fees paid to insurance broker | OTHER FEES |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0283657 |
Policy instance | 1 |
Insurance contract or identification number | 0283657 | Number of Individuals Covered | 194 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $686 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,526 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $686 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0283657 |
Policy instance | 1 |
Insurance contract or identification number | 0283657 | Number of Individuals Covered | 192 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,072 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $20,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,072 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0283657 |
Policy instance | 1 |
Insurance contract or identification number | 0283657 | Number of Individuals Covered | 196 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,858 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $21,587 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,858 | Insurance broker organization code? | 3 | Insurance broker name | VHA MID-AMERICA INSURANCE SERVICES |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010171720 |
Policy instance | 3 |
Insurance contract or identification number | 000010171720 | Number of Individuals Covered | 185 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $799 | Total amount of fees paid to insurance company | USD $138 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,992 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $799 | Amount paid for insurance broker fees | 138 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000403002125 |
Policy instance | 2 |
Insurance contract or identification number | 000403002125 | Number of Individuals Covered | 25 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $69 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $685 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $69 | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400001000 |
Policy instance | 1 |
Insurance contract or identification number | 000400001000 | Number of Individuals Covered | 42 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $988 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $988 | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010171720 |
Policy instance | 3 |
Insurance contract or identification number | 000010171720 | Number of Individuals Covered | 181 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $690 | Total amount of fees paid to insurance company | USD $368 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $6,904 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $690 | Amount paid for insurance broker fees | 368 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400001000 |
Policy instance | 1 |
Insurance contract or identification number | 000400001000 | Number of Individuals Covered | 41 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $951 | Total amount of fees paid to insurance company | USD $434 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,514 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $951 | Amount paid for insurance broker fees | 434 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000403002125 |
Policy instance | 2 |
Insurance contract or identification number | 000403002125 | Number of Individuals Covered | 24 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $63 | Total amount of fees paid to insurance company | USD $31 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63 | Amount paid for insurance broker fees | 31 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | VHA MID AMERICA INS SVCS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136437 |
Policy instance | 1 |
Insurance contract or identification number | 136437 | Number of Individuals Covered | 169 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $1,004 | Total amount of fees paid to insurance company | USD $64 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,545 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,004 | Amount paid for insurance broker fees | 64 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | WATERSTONE BENEFIT ADMINISTRATORS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136437 |
Policy instance | 1 |
Insurance contract or identification number | 136437 | Number of Individuals Covered | 172 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $1,480 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,480 | Insurance broker organization code? | 3 | Insurance broker name | WATERSTONE BENEFIT ADMINISTRATORS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136437 |
Policy instance | 1 |
Insurance contract or identification number | 136437 | Number of Individuals Covered | 172 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,212 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,415 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136437 0001 |
Policy instance | 1 |
Insurance contract or identification number | 136437 0001 | Number of Individuals Covered | 168 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $1,969 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,969 | Insurance broker organization code? | 3 | Insurance broker name | WATERSTONE BENEFIT ADMINISTRATORS |
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