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CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 401k Plan overview

Plan NameCONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN
Plan identification number 515

CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CONSOLIDATED COMMUNICATIONS HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:CONSOLIDATED COMMUNICATIONS HOLDINGS, INC.
Employer identification number (EIN):020636095
NAIC Classification:517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152022-01-01VIVIAN SCHOTT2023-07-10
5152021-01-01VIVIAN SCHOTT2022-08-09
5152020-01-01VIVIAN SCHOTT2021-08-19
5152019-01-01VIVIAN SCHOTT2020-07-01
5152018-01-01
5152017-01-01
5152016-01-01VIVIAN SCHOTT DAVID HERRICK2017-08-09
5152016-01-01
5152015-01-01VIVIAN SCHOTT MATTHEW K. SMITH2016-09-23
5152014-01-01VIVIAN M. SCHOTT MATTHEW K. SMITH2015-09-22
5152013-01-01VIVIAN SCHOTT MATTHEW SMITH2014-07-02
5152012-01-01VIVIAN SCHOTT STEVE SHIRAR2013-06-21
5152011-01-01VIVIAN SCHOTT STEPHEN JONES2012-05-14
5152010-01-01VIVIAN SCHOTT STEPHEN JONES2011-07-18
5152009-01-01VIVIAN SCHOTT STEPHEN JONES2010-07-22

Plan Statistics for CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN

401k plan membership statisitcs for CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN

Measure Date Value
2022: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01261
Total number of active participants reported on line 7a of the Form 55002022-01-01107
Number of retired or separated participants receiving benefits2022-01-01142
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01249
Number of employers contributing to the scheme2022-01-010
2021: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01271
Total number of active participants reported on line 7a of the Form 55002021-01-01114
Number of retired or separated participants receiving benefits2021-01-01147
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01261
Number of employers contributing to the scheme2021-01-010
2020: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01290
Total number of active participants reported on line 7a of the Form 55002020-01-01119
Number of retired or separated participants receiving benefits2020-01-01152
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01271
Number of employers contributing to the scheme2020-01-010
2019: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01294
Total number of active participants reported on line 7a of the Form 55002019-01-01133
Number of retired or separated participants receiving benefits2019-01-01157
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01290
Number of employers contributing to the scheme2019-01-010
2018: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01290
Total number of active participants reported on line 7a of the Form 55002018-01-01135
Number of retired or separated participants receiving benefits2018-01-01159
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01294
Number of employers contributing to the scheme2018-01-010
2017: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01294
Total number of active participants reported on line 7a of the Form 55002017-01-01139
Number of retired or separated participants receiving benefits2017-01-01151
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01290
2016: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01307
Total number of active participants reported on line 7a of the Form 55002016-01-01139
Number of retired or separated participants receiving benefits2016-01-01155
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01294
2015: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01307
Total number of active participants reported on line 7a of the Form 55002015-01-01151
Number of retired or separated participants receiving benefits2015-01-01150
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01301
2014: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01307
Total number of active participants reported on line 7a of the Form 55002014-01-01159
Number of retired or separated participants receiving benefits2014-01-01148
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01307
2013: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01320
Total number of active participants reported on line 7a of the Form 55002013-01-01159
Number of retired or separated participants receiving benefits2013-01-01148
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01307
2012: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01249
Total number of active participants reported on line 7a of the Form 55002012-01-01257
Number of retired or separated participants receiving benefits2012-01-0163
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01320
2011: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01275
Total number of active participants reported on line 7a of the Form 55002011-01-01168
Number of retired or separated participants receiving benefits2011-01-0181
Total of all active and inactive participants2011-01-01249
2010: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01312
Total number of active participants reported on line 7a of the Form 55002010-01-01192
Number of retired or separated participants receiving benefits2010-01-0183
Total of all active and inactive participants2010-01-01275
2009: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01318
Total number of active participants reported on line 7a of the Form 55002009-01-01223
Number of retired or separated participants receiving benefits2009-01-0189
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01312

Form 5500 Responses for CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN

2022: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: CONSOLIDATED COMMUNICATIONS, INC. ILLINOIS BARGAINING LIFE, ACCIDENT AND LONG TERM DISABILITY BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70651-5
Policy instance 2
Insurance contract or identification number70651-5
Number of Individuals Covered7130
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $47,759
Total amount of fees paid to insurance companyUSD $48,219
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $2,137,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees48219
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered2946
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $13,810
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $727,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees13810
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70651-5
Policy instance 2
Insurance contract or identification number70651-5
Number of Individuals Covered7302
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $33,514
Total amount of fees paid to insurance companyUSD $44,813
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $2,002,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,514
Amount paid for insurance broker fees44813
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered3036
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,637
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $613,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees15637
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70651-5
Policy instance 2
Insurance contract or identification number70651-5
Number of Individuals Covered7432
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $40,629
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,828,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees40629
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered3284
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $30,347
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $692,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees30347
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70651-5
Policy instance 2
Insurance contract or identification number70651-5
Number of Individuals Covered7820
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $42,004
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,870,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,004
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered1496
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,521
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $674,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3521
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF019305
Policy instance 2
Insurance contract or identification numberF019305
Number of Individuals Covered1661
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,829
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $108,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees4829
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered1536
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $151
Total amount of fees paid to insurance companyUSD $409
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $151
Amount paid for insurance broker fees409
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF019305
Policy instance 2
Insurance contract or identification numberF019305
Number of Individuals Covered194
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,447
Total amount of fees paid to insurance companyUSD $1,866
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $114,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,447
Amount paid for insurance broker fees1866
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD127359
Policy instance 1
Insurance contract or identification numberLTD127359
Number of Individuals Covered155
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,916
Total amount of fees paid to insurance companyUSD $311
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,916
Amount paid for insurance broker fees311
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered301
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSUPPLEMENTAL LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $56,295
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 numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered307
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,555
Total amount of fees paid to insurance companyUSD $3,114
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $105,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,555
Amount paid for insurance broker fees3114
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered307
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,604
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $56,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,604
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ANALYSIS CORP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered320
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,195
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $61,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,195
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ANALYSIS CORP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered249
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,474
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $104,736
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 numberFLI960060
Policy instance 1
Insurance contract or identification numberFLI960060
Number of Individuals Covered275
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $10,820
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $108,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,820
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ANALYSIS CORP

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