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LONG TERM DISABILITY D 401k Plan overview

Plan NameLONG TERM DISABILITY D
Plan identification number 501

LONG TERM DISABILITY D Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

LULA-WESTFIELD, L.L.C. has sponsored the creation of one or more 401k plans.

Company Name:LULA-WESTFIELD, L.L.C.
Employer identification number (EIN):721353056
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONG TERM DISABILITY D

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01
5012022-03-01
5012021-06-01
5012021-03-01
5012020-06-01
5012020-03-01
5012019-06-01
5012019-03-01
5012018-06-01
5012018-03-01BRENT BLANCHARD BRENT BLANCHARD2019-06-24
5012017-06-01BRENT BLANCHARD BRENT BLANCHARD2018-10-10
5012017-03-01BRENT BLANCHARD BRENT BLANCHARD2018-10-10
5012016-06-01MIKE DAIGLE MIKE DAIGLE2017-09-05
5012016-03-01MIKE DAIGLE MIKE DAIGLE2017-06-19
5012015-06-01MIKE DAIGLE MIKE DAIGLE2016-09-29
5012015-03-01MIKE DAIGLE MIKE DAIGLE2016-09-13
5012014-06-01MIKE DAIGLE MIKE DAIGLE2015-09-17
5012014-03-01MIKE DAIGLE MIKE DAIGLE2015-07-23
5012013-06-01MIKE DAIGLE MIKE DAIGLE2014-10-22
5012013-03-01MIKE DAIGLE MIKE DAIGLE2014-07-17
5012012-06-01MIKE DAIGLE MIKE DAIGLE2013-09-10
5012012-03-01MIKE DAIGLE MIKE DAIGLE2013-06-20
5012011-06-01MIKE DAIGLE MIKE DAIGLE2012-09-26
5012011-03-01MIKE DAIGLE MIKE DAIGLE2013-01-07
5012010-03-01MIKE DAIGLE MIKE DAIGLE2011-07-25
5012009-06-01MIKE DAIGLE MIKE DAIGLE2010-09-23
5012009-03-01MIKE DAIGLE MIKE DAIGLE2010-05-10

Plan Statistics for LONG TERM DISABILITY D

401k plan membership statisitcs for LONG TERM DISABILITY D

Measure Date Value
2022: LONG TERM DISABILITY D 2022 401k membership
Total participants, beginning-of-year2022-06-01192
Total number of active participants reported on line 7a of the Form 55002022-06-01186
Total of all active and inactive participants2022-06-01186
Total participants, beginning-of-year2022-03-0193
Total number of active participants reported on line 7a of the Form 55002022-03-0191
Total of all active and inactive participants2022-03-0191
2021: LONG TERM DISABILITY D 2021 401k membership
Total participants, beginning-of-year2021-06-01214
Total number of active participants reported on line 7a of the Form 55002021-06-01192
Total of all active and inactive participants2021-06-01192
Total participants, beginning-of-year2021-03-0194
Total number of active participants reported on line 7a of the Form 55002021-03-0193
Total of all active and inactive participants2021-03-0193
2020: LONG TERM DISABILITY D 2020 401k membership
Total participants, beginning-of-year2020-06-01214
Total number of active participants reported on line 7a of the Form 55002020-06-01214
Total of all active and inactive participants2020-06-01214
Total participants, beginning-of-year2020-03-0193
Total number of active participants reported on line 7a of the Form 55002020-03-0194
Total of all active and inactive participants2020-03-0194
2019: LONG TERM DISABILITY D 2019 401k membership
Total participants, beginning-of-year2019-06-01201
Total number of active participants reported on line 7a of the Form 55002019-06-01214
Total of all active and inactive participants2019-06-01214
Total participants, beginning-of-year2019-03-0187
Total number of active participants reported on line 7a of the Form 55002019-03-0193
Total of all active and inactive participants2019-03-0193
2018: LONG TERM DISABILITY D 2018 401k membership
Total participants, beginning-of-year2018-06-01218
Total number of active participants reported on line 7a of the Form 55002018-06-01201
Total of all active and inactive participants2018-06-01201
Total participants, beginning-of-year2018-03-0185
Total number of active participants reported on line 7a of the Form 55002018-03-0187
Total of all active and inactive participants2018-03-0187
2017: LONG TERM DISABILITY D 2017 401k membership
Total participants, beginning-of-year2017-06-01216
Total number of active participants reported on line 7a of the Form 55002017-06-01218
Total of all active and inactive participants2017-06-01218
Total participants, beginning-of-year2017-03-0187
Total number of active participants reported on line 7a of the Form 55002017-03-0185
Total of all active and inactive participants2017-03-0185
2016: LONG TERM DISABILITY D 2016 401k membership
Total participants, beginning-of-year2016-06-01202
Total number of active participants reported on line 7a of the Form 55002016-06-01216
Total of all active and inactive participants2016-06-01216
Total participants, beginning-of-year2016-03-0190
Total number of active participants reported on line 7a of the Form 55002016-03-0187
Total of all active and inactive participants2016-03-0187
2015: LONG TERM DISABILITY D 2015 401k membership
Total participants, beginning-of-year2015-06-01209
Total number of active participants reported on line 7a of the Form 55002015-06-01202
Total of all active and inactive participants2015-06-01202
Total participants, beginning-of-year2015-03-0195
Total number of active participants reported on line 7a of the Form 55002015-03-0190
Total of all active and inactive participants2015-03-0190
2014: LONG TERM DISABILITY D 2014 401k membership
Total participants, beginning-of-year2014-06-01209
Total number of active participants reported on line 7a of the Form 55002014-06-01209
Total of all active and inactive participants2014-06-01209
Total participants, beginning-of-year2014-03-0196
Total number of active participants reported on line 7a of the Form 55002014-03-0195
Total of all active and inactive participants2014-03-0195
2013: LONG TERM DISABILITY D 2013 401k membership
Total participants, beginning-of-year2013-06-01206
Total number of active participants reported on line 7a of the Form 55002013-06-01209
Total of all active and inactive participants2013-06-01209
Total participants, beginning-of-year2013-03-01102
Total number of active participants reported on line 7a of the Form 55002013-03-0196
Total of all active and inactive participants2013-03-0196
2012: LONG TERM DISABILITY D 2012 401k membership
Total participants, beginning-of-year2012-06-01194
Total number of active participants reported on line 7a of the Form 55002012-06-01206
Total of all active and inactive participants2012-06-01206
Total participants, beginning-of-year2012-03-01101
Total number of active participants reported on line 7a of the Form 55002012-03-01102
Total of all active and inactive participants2012-03-01102
2011: LONG TERM DISABILITY D 2011 401k membership
Total participants, beginning-of-year2011-06-01197
Total number of active participants reported on line 7a of the Form 55002011-06-01194
Total of all active and inactive participants2011-06-01194
Total participants, beginning-of-year2011-03-01103
Total number of active participants reported on line 7a of the Form 55002011-03-01101
Total of all active and inactive participants2011-03-01101
2010: LONG TERM DISABILITY D 2010 401k membership
Total participants, beginning-of-year2010-03-01114
Total number of active participants reported on line 7a of the Form 55002010-03-01103
Total of all active and inactive participants2010-03-01103
2009: LONG TERM DISABILITY D 2009 401k membership
Total participants, beginning-of-year2009-06-01217
Total number of active participants reported on line 7a of the Form 55002009-06-01109
Total of all active and inactive participants2009-06-01109
Total participants, beginning-of-year2009-03-01121
Total number of active participants reported on line 7a of the Form 55002009-03-01114
Total of all active and inactive participants2009-03-01114

Form 5500 Responses for LONG TERM DISABILITY D

2022: LONG TERM DISABILITY D 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – InsuranceYes
2021: LONG TERM DISABILITY D 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – InsuranceYes
2020: LONG TERM DISABILITY D 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – InsuranceYes
2019: LONG TERM DISABILITY D 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: LONG TERM DISABILITY D 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: LONG TERM DISABILITY D 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: LONG TERM DISABILITY D 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: LONG TERM DISABILITY D 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-03-01Type of plan entitySingle employer plan
2015-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: LONG TERM DISABILITY D 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: LONG TERM DISABILITY D 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: LONG TERM DISABILITY D 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: LONG TERM DISABILITY D 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: LONG TERM DISABILITY D 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: LONG TERM DISABILITY D 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedYes
2009-06-01This submission is the final filingNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-03-01Type of plan entitySingle employer plan
2009-03-01This submission is the final filingNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered186
Insurance policy start date2022-06-01
Insurance policy end date2023-06-01
Total amount of commissions paid to insurance brokerUSD $38,074
Total amount of fees paid to insurance companyUSD $20,754
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,074
Amount paid for insurance broker fees20754
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered91
Insurance policy start date2022-03-01
Insurance policy end date2023-03-01
Total amount of commissions paid to insurance brokerUSD $6,301
Total amount of fees paid to insurance companyUSD $1,626
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,301
Amount paid for insurance broker fees1626
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered192
Insurance policy start date2021-06-01
Insurance policy end date2022-06-01
Total amount of commissions paid to insurance brokerUSD $34,482
Total amount of fees paid to insurance companyUSD $20,500
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,482
Amount paid for insurance broker fees20500
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered93
Insurance policy start date2021-03-01
Insurance policy end date2022-03-01
Total amount of commissions paid to insurance brokerUSD $6,345
Total amount of fees paid to insurance companyUSD $1,904
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,345
Insurance broker organization code?3
Amount paid for insurance broker fees1904
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered214
Insurance policy start date2020-06-01
Insurance policy end date2021-06-01
Total amount of commissions paid to insurance brokerUSD $33,329
Total amount of fees paid to insurance companyUSD $19,060
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,329
Amount paid for insurance broker fees19060
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered94
Insurance policy start date2020-03-01
Insurance policy end date2021-03-01
Total amount of commissions paid to insurance brokerUSD $6,296
Total amount of fees paid to insurance companyUSD $2,006
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,296
Insurance broker organization code?3
Amount paid for insurance broker fees2006
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered214
Insurance policy start date2019-06-01
Insurance policy end date2020-06-01
Total amount of commissions paid to insurance brokerUSD $29,315
Total amount of fees paid to insurance companyUSD $18,364
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,315
Amount paid for insurance broker fees18364
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered93
Insurance policy start date2019-03-01
Insurance policy end date2020-03-01
Total amount of commissions paid to insurance brokerUSD $6,113
Total amount of fees paid to insurance companyUSD $1,186
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,113
Insurance broker organization code?3
Amount paid for insurance broker fees1186
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Insurance policy start date2018-06-01
Insurance policy end date2019-06-01
Total amount of commissions paid to insurance brokerUSD $124
Total amount of fees paid to insurance companyUSD $146
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $7,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $124
Amount paid for insurance broker fees146
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered201
Insurance policy start date2018-06-01
Insurance policy end date2019-06-01
Total amount of commissions paid to insurance brokerUSD $29,154
Total amount of fees paid to insurance companyUSD $21,763
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,154
Amount paid for insurance broker fees21763
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered87
Insurance policy start date2018-03-01
Insurance policy end date2019-03-01
Total amount of commissions paid to insurance brokerUSD $5,949
Total amount of fees paid to insurance companyUSD $433
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,949
Insurance broker organization code?3
Amount paid for insurance broker fees433
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Insurance policy start date2017-06-01
Insurance policy end date2018-06-01
Total amount of commissions paid to insurance brokerUSD $683
Total amount of fees paid to insurance companyUSD $98
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $7,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $683
Amount paid for insurance broker fees98
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered218
Insurance policy start date2017-06-01
Insurance policy end date2018-06-01
Total amount of commissions paid to insurance brokerUSD $31,541
Total amount of fees paid to insurance companyUSD $20,167
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,541
Amount paid for insurance broker fees20167
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered85
Insurance policy start date2017-03-01
Insurance policy end date2018-03-01
Total amount of commissions paid to insurance brokerUSD $5,760
Total amount of fees paid to insurance companyUSD $1,154
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,760
Insurance broker organization code?3
Amount paid for insurance broker fees1154
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered202
Insurance policy start date2015-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $29,266
Total amount of fees paid to insurance companyUSD $18,639
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,266
Amount paid for insurance broker fees18639
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Insurance policy start date2015-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $644
Total amount of fees paid to insurance companyUSD $253
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $644
Amount paid for insurance broker fees253
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered90
Insurance policy start date2015-03-01
Insurance policy end date2016-03-01
Total amount of commissions paid to insurance brokerUSD $5,316
Total amount of fees paid to insurance companyUSD $1,050
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,316
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Amount paid for insurance broker fees1050
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Insurance policy start date2014-06-01
Insurance policy end date2015-06-01
Total amount of commissions paid to insurance brokerUSD $620
Total amount of fees paid to insurance companyUSD $186
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $620
Amount paid for insurance broker fees186
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Insurance policy start date2014-06-01
Insurance policy end date2015-06-01
Total amount of commissions paid to insurance brokerUSD $39,281
Total amount of fees paid to insurance companyUSD $18,602
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,281
Amount paid for insurance broker fees18602
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES BATON RO
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered95
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $5,255
Total amount of fees paid to insurance companyUSD $1,336
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,255
Amount paid for insurance broker fees1336
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered209
Insurance policy start date2013-06-01
Insurance policy end date2014-06-01
Total amount of commissions paid to insurance brokerUSD $40,411
Total amount of fees paid to insurance companyUSD $18,493
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,938
Amount paid for insurance broker fees5006
Additional information about fees paid to insurance brokerBONUS AND INCENTIVES
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTEGRATED INSURA
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Number of Individuals Covered119
Insurance policy start date2013-06-01
Insurance policy end date2014-06-01
Total amount of commissions paid to insurance brokerUSD $633
Total amount of fees paid to insurance companyUSD $141
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $573
Amount paid for insurance broker fees96
Additional information about fees paid to insurance brokerBONUS AND INCENTIVES
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTERGRATED INSURA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered96
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $5,339
Total amount of fees paid to insurance companyUSD $554
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,482
Insurance broker organization code?3
Amount paid for insurance broker fees554
Insurance broker nameINTEGRATED INSURANCE SOLUTIONS,LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered206
Insurance policy start date2012-06-01
Insurance policy end date2013-06-01
Total amount of commissions paid to insurance brokerUSD $38,197
Total amount of fees paid to insurance companyUSD $17,795
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,197
Amount paid for insurance broker fees17795
Additional information about fees paid to insurance brokerBONUSES AND INCENTIVES
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTERGRATED INSURA
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Number of Individuals Covered126
Insurance policy start date2012-06-01
Insurance policy end date2013-06-01
Total amount of commissions paid to insurance brokerUSD $591
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $591
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTERGRATED INSURA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AKZH
Policy instance 1
Insurance contract or identification numberG000AKZH
Number of Individuals Covered102
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $5,316
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,316
Insurance broker organization code?3
Insurance broker nameINTEGRATED INSURANCE SOLUTIONS,LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered194
Insurance policy start date2011-06-01
Insurance policy end date2012-06-01
Total amount of commissions paid to insurance brokerUSD $38,488
Total amount of fees paid to insurance companyUSD $13,870
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Number of Individuals Covered113
Insurance policy start date2011-06-01
Insurance policy end date2012-06-01
Total amount of commissions paid to insurance brokerUSD $311
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number063796
Policy instance 1
Insurance contract or identification number063796
Number of Individuals Covered101
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $5,542
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SOUTHERN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60009 )
Policy contract number78622ERC
Policy instance 2
Insurance contract or identification number78622ERC
Number of Individuals Covered126
Insurance policy start date2010-06-01
Insurance policy end date2011-06-01
Total amount of commissions paid to insurance brokerUSD $321
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD &D
Welfare Benefit Premiums Paid to CarrierUSD $6,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $321
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTERGRATED INSURA
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78622ERC
Policy instance 1
Insurance contract or identification number78622ERC
Number of Individuals Covered199
Insurance policy start date2010-06-01
Insurance policy end date2011-06-01
Total amount of commissions paid to insurance brokerUSD $36,822
Total amount of fees paid to insurance companyUSD $14,501
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,822
Amount paid for insurance broker fees14501
Additional information about fees paid to insurance brokerBONUSES AND INCENTIVES
Insurance broker organization code?3
Insurance broker nameMELODY G. RYLAND-INTERGRATED INSURA
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number063796
Policy instance 1
Insurance contract or identification number063796
Number of Individuals Covered103
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $5,525
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,525
Insurance broker nameINSURANCE UNLIMITED AGENCY INC

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