401k Plan data: MAXIM GROUP LLC INSURANCE PLAN plan

MAXIM GROUP LLC INSURANCE PLAN 401k Plan overview

Plan Name	MAXIM GROUP LLC INSURANCE PLAN
Plan identification number	501

MAXIM GROUP LLC INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

MAXIM GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: MAXIM GROUP, LLC

Employer identification number (EIN): 043640096

NAIC Classification: 523120
NAIC Description: Securities Brokerage

Additional information about MAXIM GROUP, LLC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2002-04-11

Company Identification Number: 2754042

Legal Registered Office Address: 300 park avenue
16th floor
NEW YORK
United States of America (USA)
10022

More information about MAXIM GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAXIM GROUP LLC INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JOSEPH SERGIO 2023-07-19
501 2021-01-01 JOSEPH SERGIO 2022-10-10
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 JOSEPH SERGIO
501 2016-01-01 JOSEPH SERGIO
501 2015-01-01 JOSEPH SERGIO
501 2014-01-01 JOSEPH SERGIO
501 2013-01-01 JOSEPH SERGIO
501 2012-01-01 JOSEPH SERGIO
501 2011-01-01 JOSEPH SERGIO
501 2010-01-01 JOSEPH SERGIO
501 2009-01-01 JOSEPH SERGIO

Plan Statistics for MAXIM GROUP LLC INSURANCE PLAN

401k plan membership statisitcs for MAXIM GROUP LLC INSURANCE PLAN

Measure Date Value
2022: MAXIM GROUP LLC INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 118
Total of all active and inactive participants 2022-01-01 118
2021: MAXIM GROUP LLC INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 126
Total of all active and inactive participants 2021-01-01 126
2020: MAXIM GROUP LLC INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 121
Total of all active and inactive participants 2020-01-01 121
Total participants 2020-01-01 121
2019: MAXIM GROUP LLC INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 127
Total of all active and inactive participants 2019-01-01 127
Total participants 2019-01-01 127
2018: MAXIM GROUP LLC INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 137
Total of all active and inactive participants 2018-01-01 137
Total participants 2018-01-01 137
2017: MAXIM GROUP LLC INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 139
Total of all active and inactive participants 2017-01-01 139
Total participants 2017-01-01 139
2016: MAXIM GROUP LLC INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 131
Total of all active and inactive participants 2016-01-01 131
Total participants 2016-01-01 131
2015: MAXIM GROUP LLC INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 138
Total of all active and inactive participants 2015-01-01 138
Total participants 2015-01-01 0
2014: MAXIM GROUP LLC INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 158
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 148
Total of all active and inactive participants 2014-01-01 148
Total participants 2014-01-01 0
2013: MAXIM GROUP LLC INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 158
Total of all active and inactive participants 2013-01-01 158
Total participants 2013-01-01 0
2012: MAXIM GROUP LLC INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 153
Total of all active and inactive participants 2012-01-01 153
Total participants 2012-01-01 0
2011: MAXIM GROUP LLC INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 156
Total of all active and inactive participants 2011-01-01 156
Total participants 2011-01-01 156
2010: MAXIM GROUP LLC INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 161
Total of all active and inactive participants 2010-01-01 161
Total participants 2010-01-01 161
2009: MAXIM GROUP LLC INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 200
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 169
Total of all active and inactive participants 2009-01-01 169
Total participants 2009-01-01 169

Measure	Date	Value
2022: MAXIM GROUP LLC INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	118
Total of all active and inactive participants	2022-01-01	118
2021: MAXIM GROUP LLC INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	126
Total of all active and inactive participants	2021-01-01	126
2020: MAXIM GROUP LLC INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	121
Total of all active and inactive participants	2020-01-01	121
Total participants	2020-01-01	121
2019: MAXIM GROUP LLC INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	127
Total of all active and inactive participants	2019-01-01	127
Total participants	2019-01-01	127
2018: MAXIM GROUP LLC INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	137
Total of all active and inactive participants	2018-01-01	137
Total participants	2018-01-01	137
2017: MAXIM GROUP LLC INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	139
Total of all active and inactive participants	2017-01-01	139
Total participants	2017-01-01	139
2016: MAXIM GROUP LLC INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	131
Total of all active and inactive participants	2016-01-01	131
Total participants	2016-01-01	131
2015: MAXIM GROUP LLC INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	138
Total of all active and inactive participants	2015-01-01	138
Total participants	2015-01-01	0
2014: MAXIM GROUP LLC INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	158
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	148
Total of all active and inactive participants	2014-01-01	148
Total participants	2014-01-01	0
2013: MAXIM GROUP LLC INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	158
Total of all active and inactive participants	2013-01-01	158
Total participants	2013-01-01	0
2012: MAXIM GROUP LLC INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	153
Total of all active and inactive participants	2012-01-01	153
Total participants	2012-01-01	0
2011: MAXIM GROUP LLC INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	156
Total of all active and inactive participants	2011-01-01	156
Total participants	2011-01-01	156
2010: MAXIM GROUP LLC INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	161
Total of all active and inactive participants	2010-01-01	161
Total participants	2010-01-01	161
2009: MAXIM GROUP LLC INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	169
Total of all active and inactive participants	2009-01-01	169
Total participants	2009-01-01	169

Form 5500 Responses for MAXIM GROUP LLC INSURANCE PLAN

2022: MAXIM GROUP LLC INSURANCE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: MAXIM GROUP LLC INSURANCE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MAXIM GROUP LLC INSURANCE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MAXIM GROUP LLC INSURANCE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MAXIM GROUP LLC INSURANCE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MAXIM GROUP LLC INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MAXIM GROUP LLC INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: MAXIM GROUP LLC INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: MAXIM GROUP LLC INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MAXIM GROUP LLC INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MAXIM GROUP LLC INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MAXIM GROUP LLC INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: MAXIM GROUP LLC INSURANCE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MAXIM GROUP LLC INSURANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	53
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $6,333
Total amount of fees paid to insurance company	USD $844
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,333
Amount paid for insurance broker fees	844
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0243814

Policy instance

Insurance contract or identification number	0243814
Number of Individuals Covered	350
Insurance policy start date	2022-01-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $28,505
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,961
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0667394

Policy instance

Insurance contract or identification number	R0667394
Number of Individuals Covered	31
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $1,002
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, CRPACCVO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $493
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

917166

Policy instance

Insurance contract or identification number	917166
Number of Individuals Covered	127
Insurance policy start date	2022-01-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $5,922
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,948
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155

Policy instance

Insurance contract or identification number	423155
Number of Individuals Covered	217
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $7,047
Total amount of fees paid to insurance company	USD $1,522
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,047
Amount paid for insurance broker fees	1522
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423154

Policy instance

Insurance contract or identification number	423154
Number of Individuals Covered	42
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $5,743
Total amount of fees paid to insurance company	USD $766
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,743
Amount paid for insurance broker fees	766
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0182117

Policy instance

Insurance contract or identification number	0182117
Number of Individuals Covered	280
Insurance policy start date	2022-03-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $101,605
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,908
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155-001

Policy instance

Insurance contract or identification number	423155-001
Number of Individuals Covered	195
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $6,662
Total amount of fees paid to insurance company	USD $1,399
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,662
Amount paid for insurance broker fees	1399
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423154

Policy instance

Insurance contract or identification number	423154
Number of Individuals Covered	44
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $3,808
Total amount of fees paid to insurance company	USD $508
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,808
Amount paid for insurance broker fees	508
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	55
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $5,548
Total amount of fees paid to insurance company	USD $740
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,548
Amount paid for insurance broker fees	740
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0243814

Policy instance

Insurance contract or identification number	0243814
Number of Individuals Covered	345
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $113,615
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91,383
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

917166

Policy instance

Insurance contract or identification number	917166
Number of Individuals Covered	128
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $25,414
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,943
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0667394

Policy instance

Insurance contract or identification number	R0667394
Number of Individuals Covered	32
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $875
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, CRPACCVO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $433
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155-002

Policy instance

Insurance contract or identification number	423155-002
Number of Individuals Covered	29
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $346
Total amount of fees paid to insurance company	USD $48
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $346
Amount paid for insurance broker fees	48
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155-003

Policy instance

Insurance contract or identification number	423155-003
Number of Individuals Covered	2
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $55
Total amount of fees paid to insurance company	USD $14
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155-004

Policy instance

Insurance contract or identification number	423155-004
Number of Individuals Covered	3
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $91
Total amount of fees paid to insurance company	USD $23
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423154

Policy instance

Insurance contract or identification number	423154
Number of Individuals Covered	48
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $5,315
Total amount of fees paid to insurance company	USD $709
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,315
Amount paid for insurance broker fees	709
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	58
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $6,701
Total amount of fees paid to insurance company	USD $893
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,701
Amount paid for insurance broker fees	893
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0667394

Policy instance

Insurance contract or identification number	R0667394
Number of Individuals Covered	32
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $965
Other welfare benefits provided	GCIEE, CRPACCVO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $480
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155

Policy instance

Insurance contract or identification number	423155
Number of Individuals Covered	6
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $5,747
Total amount of fees paid to insurance company	USD $917
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,747
Amount paid for insurance broker fees	917
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

917166

Policy instance

Insurance contract or identification number	917166
Number of Individuals Covered	626
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $20,949
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,966
Insurance broker organization code?	3

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MG12519

Policy instance

Insurance contract or identification number	MG12519
Number of Individuals Covered	325
Insurance policy start date	2020-01-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $13,249
Total amount of fees paid to insurance company	USD $3,416
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,249
Insurance broker organization code?	3
Amount paid for insurance broker fees	3416
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0243814

Policy instance

Insurance contract or identification number	0243814
Number of Individuals Covered	346
Insurance policy start date	2020-03-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $74,473
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,031
Insurance broker organization code?	3

PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )

Policy contract number

0000163778

Policy instance

Insurance contract or identification number	0000163778
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $9,336
Total amount of fees paid to insurance company	USD $2,538
Other welfare benefits provided	DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,336
Amount paid for insurance broker fees	1604
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0667394

Policy instance

Insurance contract or identification number	R0667394
Number of Individuals Covered	37
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $1,331
Total amount of fees paid to insurance company	USD $34
Other welfare benefits provided	GCIEE, GRPACCVO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $480
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	4

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MG12519

Policy instance

Insurance contract or identification number	MG12519
Number of Individuals Covered	340
Insurance policy start date	2019-03-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $66,322
Total amount of fees paid to insurance company	USD $16,086
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,534,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,322
Insurance broker organization code?	3
Amount paid for insurance broker fees	16086
Additional information about fees paid to insurance broker	BONUS, ADMIN SVCS, NON-MONETARY PAYMENT

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0917166

Policy instance

Insurance contract or identification number	0917166
Number of Individuals Covered	357
Insurance policy start date	2019-03-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $21,795
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,530
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	140
Insurance policy start date	2019-01-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $3,214
Total amount of fees paid to insurance company	USD $1,286
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,214
Insurance broker organization code?	3
Amount paid for insurance broker fees	1286
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	58
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $5,565
Total amount of fees paid to insurance company	USD $742
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,565
Amount paid for insurance broker fees	742
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0667394

Policy instance

Insurance contract or identification number	R0667394
Number of Individuals Covered	43
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,908
Total amount of fees paid to insurance company	USD $271
Other welfare benefits provided	GCIEE, GRPACCVO
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,261
Amount paid for insurance broker fees	147
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 )

Policy contract number

0000163778

Policy instance

Insurance contract or identification number	0000163778
Number of Individuals Covered	15
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,801
Total amount of fees paid to insurance company	USD $3,155
Other welfare benefits provided	DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,801
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155 0004

Policy instance

Insurance contract or identification number	423155 0004
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $19
Total amount of fees paid to insurance company	USD $5
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155 0003

Policy instance

Insurance contract or identification number	423155 0003
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12
Total amount of fees paid to insurance company	USD $3
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Amount paid for insurance broker fees	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

865905

Policy instance

Insurance contract or identification number	865905
Number of Individuals Covered	349
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $116,274
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,990,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,181
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	144
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $19,193
Total amount of fees paid to insurance company	USD $7,677
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,193
Insurance broker organization code?	3
Amount paid for insurance broker fees	7677
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423154

Policy instance

Insurance contract or identification number	423154
Number of Individuals Covered	52
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,077
Total amount of fees paid to insurance company	USD $544
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,077
Amount paid for insurance broker fees	544
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155 0002

Policy instance

Insurance contract or identification number	423155 0002
Number of Individuals Covered	43
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $367
Total amount of fees paid to insurance company	USD $52
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $367
Amount paid for insurance broker fees	52
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155 0001

Policy instance

Insurance contract or identification number	423155 0001
Number of Individuals Covered	237
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,877
Total amount of fees paid to insurance company	USD $871
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,877
Amount paid for insurance broker fees	871
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	28
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,002
Total amount of fees paid to insurance company	USD $800
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,002
Amount paid for insurance broker fees	800
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423155

Policy instance

Insurance contract or identification number	423155
Number of Individuals Covered	237
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,940
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,940
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES, INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	42
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,496
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,496
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES, INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

423153

Policy instance

Insurance contract or identification number	423153
Number of Individuals Covered	26
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,038
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,038
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES, INC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	142
Insurance policy start date	2016-05-01
Insurance policy end date	2017-04-30
Total amount of commissions paid to insurance broker	USD $18,733
Total amount of fees paid to insurance company	USD $7,493
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,733
Insurance broker organization code?	3
Amount paid for insurance broker fees	7493
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS
Insurance broker name	CENTERSTONE INS & FIN SERV

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

865905

Policy instance

Insurance contract or identification number	865905
Insurance policy start date	2016-05-01
Insurance policy end date	2017-04-30
Total amount of commissions paid to insurance broker	USD $112,718
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,932
Insurance broker organization code?	3
Insurance broker name	CENTERSTONE INS & FIN SERV

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	146
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,990
Total amount of fees paid to insurance company	USD $7,596
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,990
Insurance broker organization code?	3
Amount paid for insurance broker fees	7596
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker name	CENTERSTONE INS & FIN SERV

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	301
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,955
Other welfare benefits provided	STATE DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $24,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,955
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	72
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $4,039
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,039
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	41
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $4,292
Total amount of fees paid to insurance company	USD $25
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,292
Insurance broker organization code?	3
Amount paid for insurance broker fees	25
Additional information about fees paid to insurance broker	THIRD PARTY FEE
Insurance broker name	COMPSYCH CORPORATION

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

865905

Policy instance

Insurance contract or identification number	865905
Number of Individuals Covered	324
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $137,491
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,119,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114,576
Insurance broker organization code?	3
Insurance broker name	CENTERSTONE INS & FIN SERV

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	70
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $4,226
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,226
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	165
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $51,184
Total amount of fees paid to insurance company	USD $21,888
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $902,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,184
Insurance broker organization code?	3
Amount paid for insurance broker fees	21888
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker name	MAXIM GROUP LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

865905

Policy instance

Insurance contract or identification number	865905
Number of Individuals Covered	331
Insurance policy start date	2014-05-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $132,756
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,317,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,886
Insurance broker organization code?	3
Insurance broker name	CENTERSTONE INS & FIN SERV

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	43
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $4,312
Total amount of fees paid to insurance company	USD $26
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,312
Insurance broker organization code?	3
Amount paid for insurance broker fees	26
Additional information about fees paid to insurance broker	THIRD PARTY FEE
Insurance broker name	COMPSYCH CORPORATION

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	311
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,216
Other welfare benefits provided	STATE DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $27,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,216
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	44
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $2,896
Total amount of fees paid to insurance company	USD $31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,896
Insurance broker organization code?	3
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	THIRD PARTY FEE
Insurance broker name	COMPSYCH CORPORATION

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	166
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $111,768
Total amount of fees paid to insurance company	USD $61,037
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,274,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $111,768
Amount paid for insurance broker fees	7564
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker name	CENTERSTONE INS & FIN SERV

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	307
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,798
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,798
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	66
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $3,399
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,399
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	60
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $3,602
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,602
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	40
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $2,947
Total amount of fees paid to insurance company	USD $36
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	THIRD PARTY FEE
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $2,947
Insurance broker name	MAXIM GROUP LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TMO5732175

Policy instance

Insurance contract or identification number	TMO5732175
Number of Individuals Covered	343
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,194
Total amount of fees paid to insurance company	USD $1,265
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,194
Amount paid for insurance broker fees	1265
Additional information about fees paid to insurance broker	SUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	302
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,786
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,786
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 )

Policy contract number

Policy instance

Number of Individuals Covered	11
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $530
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5
Insurance broker organization code?	3
Insurance broker name	RANDALL W PECK

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MG1626

Policy instance

Insurance contract or identification number	MG1626
Number of Individuals Covered	435
Insurance policy start date	2012-01-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $30,986
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $644,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,986
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3335962

Policy instance

Insurance contract or identification number	3335962
Number of Individuals Covered	162
Insurance policy start date	2012-05-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $76,443
Total amount of fees paid to insurance company	USD $33,476
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,562,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	33476
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $76,443
Insurance broker name	GARY WOOD ASSOCIATES INC

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 )

Policy contract number

Policy instance

Number of Individuals Covered	11
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $530
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	290
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,189
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TMO5732175

Policy instance

Insurance contract or identification number	TMO5732175
Number of Individuals Covered	343
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $4,323
Total amount of fees paid to insurance company	USD $2,746
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MG1626

Policy instance

Insurance contract or identification number	MG1626
Number of Individuals Covered	407
Total amount of commissions paid to insurance broker	USD $90,833
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,808,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	60
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $3,867
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	42
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $2,918
Total amount of fees paid to insurance company	USD $38
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

642678

Policy instance

Insurance contract or identification number	642678
Number of Individuals Covered	303
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,794
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,794
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TMO5732175

Policy instance

Insurance contract or identification number	TMO5732175
Number of Individuals Covered	308
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $3,986
Total amount of fees paid to insurance company	USD $1,890
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,986
Amount paid for insurance broker fees	1890
Additional information about fees paid to insurance broker	SUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY INC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MG1626

Policy instance

Insurance contract or identification number	MG1626
Number of Individuals Covered	373
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $93,589
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,855,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,589
Insurance broker organization code?	3
Insurance broker name	BWD AGENCY

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	62
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $3,457
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,457
Insurance broker organization code?	3
Insurance broker name	MAXIM GROUP LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41691

Policy instance

Insurance contract or identification number	41691
Number of Individuals Covered	45
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $2,716
Total amount of fees paid to insurance company	USD $44
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	THIRD PARTY FEE
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $2,716
Insurance broker name	MAXIM GROUP LLC

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 )

Policy contract number

Policy instance

Number of Individuals Covered	13
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $515
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5
Insurance broker organization code?	3
Insurance broker name	RANDALL W PECK

Potentially related plans

MAXIM GROUP, LLC DEFINED CONTRIBUTION PLAN [EIN = 463640096]

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Company Name:	MAXIM GROUP, LLC
Employer identification number (EIN):	043640096
NAIC Classification:	523120
NAIC Description:	Securities Brokerage

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2002-04-11
Company Identification Number:	2754042
Legal Registered Office Address:	300 park avenue 16th floor NEW YORK United States of America (USA) 10022

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	JOSEPH SERGIO	2023-07-19
501	2021-01-01	JOSEPH SERGIO	2022-10-10
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	JOSEPH SERGIO
501	2016-01-01	JOSEPH SERGIO
501	2015-01-01	JOSEPH SERGIO
501	2014-01-01	JOSEPH SERGIO
501	2013-01-01	JOSEPH SERGIO
501	2012-01-01	JOSEPH SERGIO
501	2011-01-01	JOSEPH SERGIO
501	2010-01-01	JOSEPH SERGIO
501	2009-01-01	JOSEPH SERGIO