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LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 401k Plan overview

Plan NameLEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE
Plan identification number 509

LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE Benefits

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

401k Sponsoring company profile

LEGAL SERVICES CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:LEGAL SERVICES CORPORATION
Employer identification number (EIN):521039060
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092022-01-15
5092021-01-15
5092020-01-15
5092019-01-15
5092018-01-15NINA SKAYA
5092017-01-15NINA SKAYA
5092016-01-15NINA SKAYA
5092016-01-15
5092015-01-15SOPHIA MASON
5092013-01-15SOPHIA MASON
5092012-01-15TRACI HIGGINS
5092011-01-15TRACYE BUSBEE
5092009-01-15ALICE DICKERSON

Plan Statistics for LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE

401k plan membership statisitcs for LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE

Measure Date Value
2022: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-01-15147
Total number of active participants reported on line 7a of the Form 55002022-01-15147
Number of retired or separated participants receiving benefits2022-01-150
Number of other retired or separated participants entitled to future benefits2022-01-150
Total of all active and inactive participants2022-01-15147
2021: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-01-15140
Total number of active participants reported on line 7a of the Form 55002021-01-15147
Number of retired or separated participants receiving benefits2021-01-150
Number of other retired or separated participants entitled to future benefits2021-01-150
Total of all active and inactive participants2021-01-15147
2020: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-01-15145
Total number of active participants reported on line 7a of the Form 55002020-01-15140
Number of retired or separated participants receiving benefits2020-01-150
Number of other retired or separated participants entitled to future benefits2020-01-150
Total of all active and inactive participants2020-01-15140
2019: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-01-15140
Total number of active participants reported on line 7a of the Form 55002019-01-15145
Number of retired or separated participants receiving benefits2019-01-150
Number of other retired or separated participants entitled to future benefits2019-01-150
Total of all active and inactive participants2019-01-15145
2018: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-01-15137
Total number of active participants reported on line 7a of the Form 55002018-01-15135
Number of retired or separated participants receiving benefits2018-01-150
Number of other retired or separated participants entitled to future benefits2018-01-150
Total of all active and inactive participants2018-01-15135
2017: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-01-15130
Total number of active participants reported on line 7a of the Form 55002017-01-15137
Number of retired or separated participants receiving benefits2017-01-150
Number of other retired or separated participants entitled to future benefits2017-01-150
Total of all active and inactive participants2017-01-15137
2016: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-15128
Total number of active participants reported on line 7a of the Form 55002016-01-15130
Number of retired or separated participants receiving benefits2016-01-150
Number of other retired or separated participants entitled to future benefits2016-01-150
Total of all active and inactive participants2016-01-15130
2015: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-15127
Total number of active participants reported on line 7a of the Form 55002015-01-15129
Number of retired or separated participants receiving benefits2015-01-150
Number of other retired or separated participants entitled to future benefits2015-01-150
Total of all active and inactive participants2015-01-15129
2013: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-15124
Total number of active participants reported on line 7a of the Form 55002013-01-15128
Number of retired or separated participants receiving benefits2013-01-150
Number of other retired or separated participants entitled to future benefits2013-01-150
Total of all active and inactive participants2013-01-15128
2012: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-15121
Total number of active participants reported on line 7a of the Form 55002012-01-15124
Number of retired or separated participants receiving benefits2012-01-150
Number of other retired or separated participants entitled to future benefits2012-01-150
Total of all active and inactive participants2012-01-15124
2011: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-15125
Total number of active participants reported on line 7a of the Form 55002011-01-15120
Number of retired or separated participants receiving benefits2011-01-150
Number of other retired or separated participants entitled to future benefits2011-01-150
Total of all active and inactive participants2011-01-15120
2009: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-15103
Total number of active participants reported on line 7a of the Form 55002009-01-15116
Total of all active and inactive participants2009-01-15116
Total participants2009-01-15116

Form 5500 Responses for LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE

2022: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2022 form 5500 responses
2022-01-15Type of plan entitySingle employer plan
2022-01-15Submission has been amendedNo
2022-01-15This submission is the final filingNo
2022-01-15This return/report is a short plan year return/report (less than 12 months)No
2022-01-15Plan is a collectively bargained planNo
2022-01-15Plan funding arrangement – InsuranceYes
2022-01-15Plan benefit arrangement – InsuranceYes
2021: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2021 form 5500 responses
2021-01-15Type of plan entitySingle employer plan
2021-01-15Submission has been amendedNo
2021-01-15This submission is the final filingNo
2021-01-15This return/report is a short plan year return/report (less than 12 months)No
2021-01-15Plan is a collectively bargained planNo
2021-01-15Plan funding arrangement – InsuranceYes
2021-01-15Plan benefit arrangement – InsuranceYes
2020: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2020 form 5500 responses
2020-01-15Type of plan entitySingle employer plan
2020-01-15Submission has been amendedNo
2020-01-15This submission is the final filingNo
2020-01-15This return/report is a short plan year return/report (less than 12 months)No
2020-01-15Plan is a collectively bargained planNo
2020-01-15Plan funding arrangement – InsuranceYes
2020-01-15Plan benefit arrangement – InsuranceYes
2019: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2019 form 5500 responses
2019-01-15Type of plan entitySingle employer plan
2019-01-15Submission has been amendedNo
2019-01-15This submission is the final filingNo
2019-01-15This return/report is a short plan year return/report (less than 12 months)No
2019-01-15Plan is a collectively bargained planNo
2019-01-15Plan funding arrangement – InsuranceYes
2019-01-15Plan benefit arrangement – InsuranceYes
2018: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2018 form 5500 responses
2018-01-15Type of plan entitySingle employer plan
2018-01-15Submission has been amendedNo
2018-01-15This submission is the final filingNo
2018-01-15This return/report is a short plan year return/report (less than 12 months)No
2018-01-15Plan is a collectively bargained planNo
2018-01-15Plan funding arrangement – InsuranceYes
2018-01-15Plan benefit arrangement – InsuranceYes
2017: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2017 form 5500 responses
2017-01-15Type of plan entitySingle employer plan
2017-01-15Submission has been amendedNo
2017-01-15This submission is the final filingNo
2017-01-15This return/report is a short plan year return/report (less than 12 months)No
2017-01-15Plan is a collectively bargained planNo
2017-01-15Plan funding arrangement – InsuranceYes
2017-01-15Plan benefit arrangement – InsuranceYes
2016: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2016 form 5500 responses
2016-01-15Type of plan entitySingle employer plan
2016-01-15Submission has been amendedYes
2016-01-15This submission is the final filingNo
2016-01-15This return/report is a short plan year return/report (less than 12 months)No
2016-01-15Plan is a collectively bargained planNo
2016-01-15Plan funding arrangement – InsuranceYes
2016-01-15Plan benefit arrangement – InsuranceYes
2015: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2015 form 5500 responses
2015-01-15Type of plan entitySingle employer plan
2015-01-15Submission has been amendedNo
2015-01-15This submission is the final filingNo
2015-01-15This return/report is a short plan year return/report (less than 12 months)No
2015-01-15Plan is a collectively bargained planNo
2015-01-15Plan funding arrangement – InsuranceYes
2015-01-15Plan benefit arrangement – InsuranceYes
2013: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2013 form 5500 responses
2013-01-15Type of plan entitySingle employer plan
2013-01-15Submission has been amendedNo
2013-01-15This submission is the final filingNo
2013-01-15This return/report is a short plan year return/report (less than 12 months)No
2013-01-15Plan is a collectively bargained planNo
2013-01-15Plan funding arrangement – InsuranceYes
2013-01-15Plan benefit arrangement – InsuranceYes
2012: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2012 form 5500 responses
2012-01-15Type of plan entitySingle employer plan
2012-01-15Submission has been amendedNo
2012-01-15This submission is the final filingNo
2012-01-15This return/report is a short plan year return/report (less than 12 months)No
2012-01-15Plan is a collectively bargained planNo
2012-01-15Plan funding arrangement – InsuranceYes
2012-01-15Plan benefit arrangement – InsuranceYes
2011: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2011 form 5500 responses
2011-01-15Type of plan entitySingle employer plan
2011-01-15Submission has been amendedNo
2011-01-15This submission is the final filingNo
2011-01-15This return/report is a short plan year return/report (less than 12 months)No
2011-01-15Plan is a collectively bargained planNo
2011-01-15Plan funding arrangement – InsuranceYes
2011-01-15Plan benefit arrangement – InsuranceYes
2009: LEGAL SERVICES CORPORATION TRAVEL ACCIDENT INSURANCE 2009 form 5500 responses
2009-01-15Type of plan entitySingle employer plan
2009-01-15Submission has been amendedNo
2009-01-15This submission is the final filingNo
2009-01-15This return/report is a short plan year return/report (less than 12 months)No
2009-01-15Plan is a collectively bargained planNo
2009-01-15Plan funding arrangement – InsuranceYes
2009-01-15Plan 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 numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered147
Insurance policy start date2022-01-15
Insurance policy end date2023-01-14
Total amount of commissions paid to insurance brokerUSD $142
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered147
Insurance policy start date2021-01-15
Insurance policy end date2022-01-14
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered140
Insurance policy start date2020-01-15
Insurance policy end date2021-01-14
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered145
Insurance policy start date2019-01-15
Insurance policy end date2020-01-14
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered135
Insurance policy start date2018-01-15
Insurance policy end date2019-01-14
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered137
Insurance policy start date2017-01-15
Insurance policy end date2018-01-14
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameTHE CIMA COMPANIES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered129
Insurance policy start date2014-01-15
Insurance policy end date2015-01-14
Total amount of commissions paid to insurance brokerUSD $143
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
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameTHE CIMA COMPANIES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered128
Insurance policy start date2012-01-15
Insurance policy end date2013-01-14
Total amount of commissions paid to insurance brokerUSD $405
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
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
Insurance broker nameTHE CIMA COMPANIES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered124
Insurance policy start date2012-01-15
Insurance policy end date2013-01-14
Total amount of commissions paid to insurance brokerUSD $405
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
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
Insurance broker nameTHE CIMA COMPANIES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered120
Insurance policy start date2011-01-15
Insurance policy end date2012-01-14
Total amount of commissions paid to insurance brokerUSD $135
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
Other welfare benefits providedTRAVEL ACCIDENT 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 CarrierUSD $900
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 numberABL620588
Policy instance 1
Insurance contract or identification numberABL620588
Number of Individuals Covered125
Insurance policy start date2010-01-15
Insurance policy end date2011-01-14
Total amount of commissions paid to insurance brokerUSD $135
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135
Insurance broker organization code?3
Insurance broker nameTHE CIMA COMPANIES

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