J&J INDUSTRIES, INC. J&J FLOORING GROUP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN
401k plan membership statisitcs for J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2016: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 699 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 0 |
| 2015: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 736 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 687 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 12 |
| Total of all active and inactive participants | 2015-01-01 | 699 |
| 2014: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 759 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 725 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 11 |
| Total of all active and inactive participants | 2014-07-01 | 736 |
| 2013: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 727 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 759 |
| Total of all active and inactive participants | 2013-07-01 | 759 |
| 2012: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 757 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 724 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 3 |
| Total of all active and inactive participants | 2012-07-01 | 727 |
| Total participants | 2012-07-01 | 727 |
| 2011: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 661 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 750 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 7 |
| Total of all active and inactive participants | 2011-07-01 | 757 |
| Total participants | 2011-07-01 | 757 |
| 2010: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 652 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 649 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 12 |
| Total of all active and inactive participants | 2010-07-01 | 661 |
| Total participants | 2010-07-01 | 661 |
| 2009: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 658 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 635 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 17 |
| Total of all active and inactive participants | 2009-07-01 | 652 |
| Total participants | 2009-07-01 | 652 |
| 2008: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-07-01 | 770 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-07-01 | 618 |
| Number of retired or separated participants receiving benefits | 2008-07-01 | 40 |
| Total of all active and inactive participants | 2008-07-01 | 658 |
| Total participants | 2008-07-01 | 658 |
| 2007: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-07-01 | 816 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-07-01 | 750 |
| Number of retired or separated participants receiving benefits | 2007-07-01 | 20 |
| Total of all active and inactive participants | 2007-07-01 | 770 |
| Total participants | 2007-07-01 | 770 |
| 2006: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-07-01 | 792 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-07-01 | 800 |
| Number of retired or separated participants receiving benefits | 2006-07-01 | 16 |
| Total of all active and inactive participants | 2006-07-01 | 816 |
| Total participants | 2006-07-01 | 816 |
| 2005: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-07-01 | 706 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-07-01 | 784 |
| Number of retired or separated participants receiving benefits | 2005-07-01 | 8 |
| Total of all active and inactive participants | 2005-07-01 | 792 |
| Total participants | 2005-07-01 | 792 |
| 2004: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-07-01 | 700 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-07-01 | 688 |
| Number of retired or separated participants receiving benefits | 2004-07-01 | 18 |
| Total of all active and inactive participants | 2004-07-01 | 706 |
| Total participants | 2004-07-01 | 706 |
| 2003: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-07-01 | 752 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-07-01 | 690 |
| Number of retired or separated participants receiving benefits | 2003-07-01 | 10 |
| Total of all active and inactive participants | 2003-07-01 | 700 |
| Total participants | 2003-07-01 | 700 |
| 2002: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-07-01 | 769 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-07-01 | 741 |
| Number of retired or separated participants receiving benefits | 2002-07-01 | 11 |
| Total of all active and inactive participants | 2002-07-01 | 752 |
| Total participants | 2002-07-01 | 752 |
| Total participants, beginning-of-year | 2002-01-01 | 787 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-01-01 | 760 |
| Number of retired or separated participants receiving benefits | 2002-01-01 | 9 |
| Total of all active and inactive participants | 2002-01-01 | 769 |
| Total participants | 2002-01-01 | 769 |
| 2016: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | Yes |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | First time form 5500 has been submitted | Yes |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | Yes |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-07-01 | Type of plan entity | Single employer plan |
| 2008-07-01 | Submission has been amended | No |
| 2008-07-01 | This submission is the final filing | No |
| 2008-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-07-01 | Plan is a collectively bargained plan | No |
| 2008-07-01 | Plan funding arrangement – Insurance | Yes |
| 2008-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-07-01 | Type of plan entity | Single employer plan |
| 2007-07-01 | Submission has been amended | No |
| 2007-07-01 | This submission is the final filing | No |
| 2007-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-07-01 | Plan is a collectively bargained plan | No |
| 2007-07-01 | Plan funding arrangement – Insurance | Yes |
| 2007-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-07-01 | Type of plan entity | Single employer plan |
| 2006-07-01 | Submission has been amended | No |
| 2006-07-01 | This submission is the final filing | No |
| 2006-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-07-01 | Plan is a collectively bargained plan | No |
| 2006-07-01 | Plan funding arrangement – Insurance | Yes |
| 2006-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-07-01 | Type of plan entity | Single employer plan |
| 2005-07-01 | Submission has been amended | No |
| 2005-07-01 | This submission is the final filing | No |
| 2005-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-07-01 | Plan is a collectively bargained plan | No |
| 2005-07-01 | Plan funding arrangement – Insurance | Yes |
| 2005-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2004 form 5500 responses |
|---|
| 2004-07-01 | Type of plan entity | Single employer plan |
| 2004-07-01 | Submission has been amended | No |
| 2004-07-01 | This submission is the final filing | No |
| 2004-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-07-01 | Plan is a collectively bargained plan | No |
| 2004-07-01 | Plan funding arrangement – Insurance | Yes |
| 2004-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2003 form 5500 responses |
|---|
| 2003-07-01 | Type of plan entity | Single employer plan |
| 2003-07-01 | Submission has been amended | No |
| 2003-07-01 | This submission is the final filing | No |
| 2003-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-07-01 | Plan is a collectively bargained plan | No |
| 2003-07-01 | Plan funding arrangement – Insurance | Yes |
| 2003-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: J & J INDUSTRIES, INC EMPLOYEE GROUP BENEFIT PLAN 2002 form 5500 responses |
|---|
| 2002-07-01 | Type of plan entity | Single employer plan |
| 2002-07-01 | Submission has been amended | No |
| 2002-07-01 | This submission is the final filing | No |
| 2002-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-07-01 | Plan is a collectively bargained plan | No |
| 2002-07-01 | Plan funding arrangement – Insurance | Yes |
| 2002-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002-01-01 | Type of plan entity | Single employer plan |
| 2002-01-01 | Submission has been amended | No |
| 2002-01-01 | This submission is the final filing | No |
| 2002-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2002-01-01 | Plan is a collectively bargained plan | No |
| 2002-01-01 | Plan funding arrangement – Insurance | Yes |
| 2002-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4351953 |
| Policy instance | 1 |
| Insurance contract or identification number | E4351953 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $5,263 | | Total amount of fees paid to insurance company | USD $1,771 | | Other welfare benefits provided | CRITICAL ILLNESS AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $22,296 | | Commission paid to Insurance Broker | USD $2 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 278 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | ANNALIESE CLARK |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4353587 |
| Policy instance | 2 |
| Insurance contract or identification number | E4353587 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $31,114 | | Total amount of fees paid to insurance company | USD $11,939 | | Other welfare benefits provided | ACCIDENT AND CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $95,745 | | Commission paid to Insurance Broker | USD $52 | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORMAC SOLUTIONS INC. |
|
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | E4351953 |
| Policy instance | 4 |
| Insurance contract or identification number | E4351953 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $8 | | Other welfare benefits provided | ACCIDENT AND CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $228 | | Commission paid to Insurance Broker | USD $8 | | Amount paid for insurance broker fees | 4 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | JENNIFER ROSE SMITH |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331709 |
| Policy instance | 5 |
| Insurance contract or identification number | 3331709 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $19 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $351 | | Commission paid to Insurance Broker | USD $19 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0283786 |
| Policy instance | 6 |
| Insurance contract or identification number | 0283786 | | Number of Individuals Covered | 716 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $18,604 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $248,778 | | Commission paid to Insurance Broker | USD $18,604 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4353587 |
| Policy instance | 1 |
| Insurance contract or identification number | E4353587 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $65,892 | | Total amount of fees paid to insurance company | USD $30,766 | | Other welfare benefits provided | ACCIDENT AND CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $108,185 | | Commission paid to Insurance Broker | USD $1 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORMAC SOLUTIONS INC. |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331709 |
| Policy instance | 2 |
| Insurance contract or identification number | 3331709 | | Number of Individuals Covered | 1293 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,286 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $305,713 | | Commission paid to Insurance Broker | USD $15,286 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960889 |
| Policy instance | 4 |
| Insurance contract or identification number | VDT960889 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,494 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,295 | | Commission paid to Insurance Broker | USD $3,494 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960890 |
| Policy instance | 5 |
| Insurance contract or identification number | VDT960890 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $10,073 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,154 | | Commission paid to Insurance Broker | USD $10,073 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4351953 |
| Policy instance | 6 |
| Insurance contract or identification number | E4351953 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,969 | | Total amount of fees paid to insurance company | USD $7,504 | | Other welfare benefits provided | CRITICAL ILLNESS AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $27,794 | | Commission paid to Insurance Broker | USD $26 | | Amount paid for insurance broker fees | 13 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ANNALIESE CLARK |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK965680 |
| Policy instance | 7 |
| Insurance contract or identification number | OK965680 | | Number of Individuals Covered | 687 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,220 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $8,133 | | Commission paid to Insurance Broker | USD $1,220 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964062 |
| Policy instance | 8 |
| Insurance contract or identification number | FLX964062 | | Number of Individuals Covered | 687 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $39,652 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $265,128 | | Commission paid to Insurance Broker | USD $39,652 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | YS380 |
| Policy instance | 7 |
| Insurance contract or identification number | YS380 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,676 | | Total amount of fees paid to insurance company | USD $937 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,917 | | Commission paid to Insurance Broker | USD $6,635 | | Amount paid for insurance broker fees | 293 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | RICHARD HEYDEL |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960890 |
| Policy instance | 6 |
| Insurance contract or identification number | VDT960890 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,910 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,733 | | Commission paid to Insurance Broker | USD $4,910 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK965680 |
| Policy instance | 5 |
| Insurance contract or identification number | OK965680 | | Number of Individuals Covered | 736 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $589 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,926 | | Commission paid to Insurance Broker | USD $589 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960889 |
| Policy instance | 4 |
| Insurance contract or identification number | VDT960889 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,871 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,875 | | Commission paid to Insurance Broker | USD $1,871 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964062 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964062 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $20,548 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $136,988 | | Commission paid to Insurance Broker | USD $20,548 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331709 |
| Policy instance | 1 |
| Insurance contract or identification number | 3331709 | | Number of Individuals Covered | 1275 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,405 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,047 | | Commission paid to Insurance Broker | USD $7,405 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960889 |
| Policy instance | 6 |
| Insurance contract or identification number | VDT960889 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,265 | | Total amount of fees paid to insurance company | USD $728 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,764 | | Commission paid to Insurance Broker | USD $3,265 | | Amount paid for insurance broker fees | 728 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK965680 |
| Policy instance | 5 |
| Insurance contract or identification number | OK965680 | | Number of Individuals Covered | 739 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,063 | | Total amount of fees paid to insurance company | USD $124 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,086 | | Commission paid to Insurance Broker | USD $1,063 | | Amount paid for insurance broker fees | 124 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964062 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964062 | | Number of Individuals Covered | 739 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $35,940 | | Total amount of fees paid to insurance company | USD $7,226 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $240,541 | | Commission paid to Insurance Broker | USD $35,940 | | Amount paid for insurance broker fees | 7226 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960890 |
| Policy instance | 1 |
| Insurance contract or identification number | VDT960890 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $9,117 | | Total amount of fees paid to insurance company | USD $1,160 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,781 | | Commission paid to Insurance Broker | USD $9,117 | | Amount paid for insurance broker fees | 1160 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331709 |
| Policy instance | 2 |
| Insurance contract or identification number | 3331709 | | Number of Individuals Covered | 1240 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $16,443 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $328,849 | | Commission paid to Insurance Broker | USD $16,443 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWESTERN BENEFIT CORP OF GA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960890 |
| Policy instance | 2 |
| Insurance contract or identification number | VDT960890 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $12,511 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $83,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,565 | | Insurance broker organization code? | 7 | | Insurance broker name | J SMITH LANIER & CO |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964062 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX964062 | | Number of Individuals Covered | 724 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $44,560 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $268,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,618 | | Insurance broker organization code? | 7 | | Insurance broker name | J SMITH LANIER & CO |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960889 |
| Policy instance | 3 |
| Insurance contract or identification number | VDT960889 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $4,442 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $29,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,029 | | Insurance broker organization code? | 7 | | Insurance broker name | J SMITH LANIER & CO |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965680 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 965680 | | Number of Individuals Covered | 724 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $1,249 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $854 | | Insurance broker organization code? | 7 | | Insurance broker name | J SMITH LANIER & CO |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965680 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 965680 | | Number of Individuals Covered | 750 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $1,071 | | Total amount of fees paid to insurance company | USD $321 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960890 |
| Policy instance | 3 |
| Insurance contract or identification number | VDT960890 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $10,404 | | Total amount of fees paid to insurance company | USD $3,307 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT960889 |
| Policy instance | 2 |
| Insurance contract or identification number | VDT960889 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $3,788 | | Total amount of fees paid to insurance company | USD $1,140 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331709 |
| Policy instance | 1 |
| Insurance contract or identification number | 3331709 | | Number of Individuals Covered | 1229 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $14,971 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $299,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964062 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX964062 | | Number of Individuals Covered | 750 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $33,738 | | Total amount of fees paid to insurance company | USD $10,099 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $225,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00079T6 |
| Policy instance | 4 |
| Insurance contract or identification number | G00079T6 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $3,855 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00079T6 |
| Policy instance | 3 |
| Insurance contract or identification number | G00079T6 | | Number of Individuals Covered | 769 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $8,732 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00076T6 |
| Policy instance | 2 |
| Insurance contract or identification number | G00076T6 | | Number of Individuals Covered | 450 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $37,702 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $155,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401140 0010 SSL |
| Policy instance | 1 |
| Insurance contract or identification number | 401140 0010 SSL | | Number of Individuals Covered | 677 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $10,025 | | Welfare Benefit Premiums Paid to Carrier | USD $200,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00079T6 |
| Policy instance | 5 |
| Insurance contract or identification number | G00079T6 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $11,317 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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