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CAMBA, INC. BENEFITS PLAN 401k Plan overview

Plan NameCAMBA, INC. BENEFITS PLAN
Plan identification number 501

CAMBA, INC. BENEFITS PLAN Benefits

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

401k Sponsoring company profile

CAMBA, INC has sponsored the creation of one or more 401k plans.

Company Name:CAMBA, INC
Employer identification number (EIN):112480339
NAIC Classification:624200

Additional information about CAMBA, INC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1978-03-07
Company Identification Number: 475763
Legal Registered Office Address: 187 WOLF ROAD
SUITE 101
ALBANY
United States of America (USA)
12205

More information about CAMBA, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAMBA, INC. BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-03-01
5012021-03-01
5012020-03-01
5012019-03-01
5012018-03-01
5012017-03-01JOANN OPLUSTIL JOANN OPLUSTIL2018-09-20
5012016-03-01KATHY DROS KATHY DROS2017-09-25
5012015-03-01JOANNE OPLUSTIL JOANNE OPLUSTIL2016-09-23
5012014-03-01JOANNE M. OPLUSTIL JOANNE M. OPLUSTIL2015-12-11
5012013-03-01JOANNE M. OPLUSTIL JOANNE M. OPLUSTIL2014-11-21
5012012-03-01JOANNE OPLUSTIL JOANNE OPLUSTIL2013-10-02
5012011-03-01JOANNE OPLUSTIL JOANNE OPLUSTIL2012-12-19
5012010-03-01LOUISE MESSINA
5012009-03-01KATHY DROS KATHY DROS2010-09-20

Plan Statistics for CAMBA, INC. BENEFITS PLAN

401k plan membership statisitcs for CAMBA, INC. BENEFITS PLAN

Measure Date Value
2022: CAMBA, INC. BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-011,652
Total number of active participants reported on line 7a of the Form 55002022-03-011,639
Total of all active and inactive participants2022-03-011,639
2021: CAMBA, INC. BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-011,546
Total number of active participants reported on line 7a of the Form 55002021-03-011,652
Total of all active and inactive participants2021-03-011,652
2020: CAMBA, INC. BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-011,384
Total number of active participants reported on line 7a of the Form 55002020-03-011,546
Total of all active and inactive participants2020-03-011,546
2019: CAMBA, INC. BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-011,349
Total number of active participants reported on line 7a of the Form 55002019-03-011,384
Total of all active and inactive participants2019-03-011,384
2018: CAMBA, INC. BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-011,897
Total number of active participants reported on line 7a of the Form 55002018-03-011,349
Total of all active and inactive participants2018-03-011,349
2017: CAMBA, INC. BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-011,701
Total number of active participants reported on line 7a of the Form 55002017-03-011,897
Total of all active and inactive participants2017-03-011,897
2016: CAMBA, INC. BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-011,603
Total number of active participants reported on line 7a of the Form 55002016-03-011,701
Total of all active and inactive participants2016-03-011,701
2015: CAMBA, INC. BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-011,380
Total number of active participants reported on line 7a of the Form 55002015-03-011,603
Total of all active and inactive participants2015-03-011,603
2014: CAMBA, INC. BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-011,264
Total number of active participants reported on line 7a of the Form 55002014-03-011,380
Total of all active and inactive participants2014-03-011,380
2013: CAMBA, INC. BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-011,186
Total number of active participants reported on line 7a of the Form 55002013-03-011,264
Total of all active and inactive participants2013-03-011,264
2012: CAMBA, INC. BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-011,068
Total number of active participants reported on line 7a of the Form 55002012-03-011,186
Total of all active and inactive participants2012-03-011,186
2011: CAMBA, INC. BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-011,122
Total number of active participants reported on line 7a of the Form 55002011-03-011,068
Total of all active and inactive participants2011-03-011,068
2010: CAMBA, INC. BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-011,085
Total number of active participants reported on line 7a of the Form 55002010-03-011,122
Number of retired or separated participants receiving benefits2010-03-010
Number of other retired or separated participants entitled to future benefits2010-03-010
Total of all active and inactive participants2010-03-011,122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-03-010
2009: CAMBA, INC. BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-011,102
Total number of active participants reported on line 7a of the Form 55002009-03-011,085
Number of retired or separated participants receiving benefits2009-03-010
Number of other retired or separated participants entitled to future benefits2009-03-010
Total of all active and inactive participants2009-03-011,085
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-03-010

Form 5500 Responses for CAMBA, INC. BENEFITS PLAN

2022: CAMBA, INC. BENEFITS PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Submission has been amendedNo
2022-03-01This submission is the final filingNo
2022-03-01This return/report is a short plan year return/report (less than 12 months)No
2022-03-01Plan is a collectively bargained planNo
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – InsuranceYes
2021: CAMBA, INC. BENEFITS PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Submission has been amendedNo
2021-03-01This submission is the final filingNo
2021-03-01This return/report is a short plan year return/report (less than 12 months)No
2021-03-01Plan is a collectively bargained planNo
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – InsuranceYes
2020: CAMBA, INC. BENEFITS PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Submission has been amendedNo
2020-03-01This submission is the final filingNo
2020-03-01This return/report is a short plan year return/report (less than 12 months)No
2020-03-01Plan is a collectively bargained planNo
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – InsuranceYes
2019: CAMBA, INC. BENEFITS PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Submission has been amendedNo
2019-03-01This submission is the final filingNo
2019-03-01This return/report is a short plan year return/report (less than 12 months)No
2019-03-01Plan is a collectively bargained planNo
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: CAMBA, INC. BENEFITS PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Submission has been amendedNo
2018-03-01This submission is the final filingNo
2018-03-01This return/report is a short plan year return/report (less than 12 months)No
2018-03-01Plan is a collectively bargained planNo
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: CAMBA, INC. BENEFITS PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Submission has been amendedNo
2017-03-01This submission is the final filingNo
2017-03-01This return/report is a short plan year return/report (less than 12 months)No
2017-03-01Plan is a collectively bargained planNo
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: CAMBA, INC. BENEFITS PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: CAMBA, INC. BENEFITS PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: CAMBA, INC. BENEFITS PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: CAMBA, INC. BENEFITS PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: CAMBA, INC. BENEFITS PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)No
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: CAMBA, INC. BENEFITS PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Submission has been amendedYes
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: CAMBA, INC. BENEFITS PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Submission has been amendedNo
2010-03-01This submission is the final filingNo
2010-03-01This return/report is a short plan year return/report (less than 12 months)No
2010-03-01Plan is a collectively bargained planNo
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: CAMBA, INC. BENEFITS PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935897
Policy instance 1
Insurance contract or identification number935897
Number of Individuals Covered1251
Insurance policy start date2022-03-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $44,851
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY,CHILD VOL. LIFE & AD&D, SPOUSE VOL. LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $448,506
Commission paid to Insurance BrokerUSD $22,425
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 5
Insurance contract or identification number00417347
Number of Individuals Covered1514
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $30,494
Total amount of fees paid to insurance companyUSD $6,900
Dental Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $479,725
Commission paid to Insurance BrokerUSD $8,351
Amount paid for insurance broker fees6900
Insurance broker organization code?3
THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )
Policy contract number448441
Policy instance 4
Insurance contract or identification number448441
Number of Individuals Covered1176
Insurance policy start date2022-11-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $5,484
Total amount of fees paid to insurance companyUSD $4,675
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,857
Commission paid to Insurance BrokerUSD $2,094
Insurance broker organization code?3
Amount paid for insurance broker fees4675
Additional information about fees paid to insurance brokerCONTINGENT COMP
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935898
Policy instance 3
Insurance contract or identification number935898
Number of Individuals Covered1639
Insurance policy start date2022-03-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $29,522
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DISABILITY LAW, PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $287,998
Commission paid to Insurance BrokerUSD $21,474
Insurance broker organization code?3
EYE MED (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10193671001
Policy instance 2
Insurance contract or identification number10193671001
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $8,199
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,353
Commission paid to Insurance BrokerUSD $8,199
Insurance broker organization code?3
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1141557 000
Policy instance 6
Insurance contract or identification number1141557 000
Number of Individuals Covered0
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $274,852
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $11,452,152
Commission paid to Insurance BrokerUSD $274,852
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935897
Policy instance 1
Insurance contract or identification number935897
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $68,879
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY,CHILD VOL. LIFE & AD&D, SPOUSE VOL. LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $688,791
Commission paid to Insurance BrokerUSD $34,439
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935898
Policy instance 3
Insurance contract or identification number935898
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $38,707
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DISABILITY LAW, PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $563,401
Commission paid to Insurance BrokerUSD $28,067
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0322627
Policy instance 4
Insurance contract or identification number0322627
Insurance policy start date2021-03-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $195,225
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,722,659
Commission paid to Insurance BrokerUSD $136,658
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 5
Insurance contract or identification number00417347
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $26,127
Total amount of fees paid to insurance companyUSD $10,207
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $522,538
Commission paid to Insurance BrokerUSD $26,127
Amount paid for insurance broker fees10207
Insurance broker organization code?3
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1141557 000
Policy instance 6
Insurance contract or identification number1141557 000
Insurance policy start date2021-11-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $101,460
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $4,227,488
Commission paid to Insurance BrokerUSD $101,460
Insurance broker organization code?3
EYE MED (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10193671001
Policy instance 2
Insurance contract or identification number10193671001
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $8,785
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,930
Commission paid to Insurance BrokerUSD $8,785
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935897
Policy instance 1
Insurance contract or identification number935897
Number of Individuals Covered1334
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $80,327
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY,CHILD VOL. LIFE & AD&D, SPOUSE VOL. LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $688,584
Commission paid to Insurance BrokerUSD $40,163
Insurance broker organization code?3
EYE MED (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10193671001
Policy instance 2
Insurance contract or identification number10193671001
Number of Individuals Covered1007
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $9,718
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,189
Commission paid to Insurance BrokerUSD $9,718
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935898
Policy instance 3
Insurance contract or identification number935898
Number of Individuals Covered1546
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $31,887
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DISABILITY LAW, PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $299,122
Commission paid to Insurance BrokerUSD $20,562
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0322627
Policy instance 4
Insurance contract or identification number0322627
Number of Individuals Covered1260
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $118,461
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,211,338
Commission paid to Insurance BrokerUSD $52,571
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 5
Insurance contract or identification number00417347
Number of Individuals Covered896
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $28,112
Total amount of fees paid to insurance companyUSD $5,715
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $562,249
Commission paid to Insurance BrokerUSD $28,112
Amount paid for insurance broker fees5715
Insurance broker organization code?3
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number247F1GL28
Policy instance 6
Insurance contract or identification number247F1GL28
Number of Individuals Covered1313
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $197,119
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $8,570,800
Commission paid to Insurance BrokerUSD $197,119
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD3-820-095118-
Policy instance 2
Insurance contract or identification numberGD3-820-095118-
Number of Individuals Covered1318
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $19,066
Total amount of fees paid to insurance companyUSD $543
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $162,835
Commission paid to Insurance BrokerUSD $19,066
Amount paid for insurance broker fees543
Insurance broker organization code?3
EYE MED (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10193671001
Policy instance 3
Insurance contract or identification number10193671001
Number of Individuals Covered1024
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $9,763
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,764
Commission paid to Insurance BrokerUSD $9,763
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935898
Policy instance 4
Insurance contract or identification number935898
Number of Individuals Covered1992
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $5,245
Other welfare benefits providedNY DISABILITY LAW, PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $174,015
Commission paid to Insurance BrokerUSD $3,095
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3-820-095118-
Policy instance 5
Insurance contract or identification numberGF3-820-095118-
Number of Individuals Covered1318
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $22,489
Total amount of fees paid to insurance companyUSD $711
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186,705
Commission paid to Insurance BrokerUSD $22,489
Amount paid for insurance broker fees711
Insurance broker organization code?3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number935897
Policy instance 1
Insurance contract or identification number935897
Number of Individuals Covered1384
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $11,365
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY,CHILD VOL. LIFE & AD&D, SPOUSE VOL. LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $228,332
Commission paid to Insurance BrokerUSD $5,682
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 8
Insurance contract or identification number247F1GL28
Number of Individuals Covered872
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $279,689
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $12,160,406
Commission paid to Insurance BrokerUSD $279,689
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 7
Insurance contract or identification number00417347
Number of Individuals Covered913
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $24,567
Total amount of fees paid to insurance companyUSD $5,632
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $491,335
Commission paid to Insurance BrokerUSD $24,567
Amount paid for insurance broker fees5632
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA3-820-095118-
Policy instance 6
Insurance contract or identification numberSA3-820-095118-
Number of Individuals Covered1318
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $20,240
Total amount of fees paid to insurance companyUSD $617
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,492
Commission paid to Insurance BrokerUSD $20,240
Amount paid for insurance broker fees617
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA382009511801
Policy instance 1
Insurance contract or identification numberSA382009511801
Number of Individuals Covered1349
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $18,908
Total amount of fees paid to insurance companyUSD $7,798
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $187,040
Commission paid to Insurance BrokerUSD $18,908
Amount paid for insurance broker fees7798
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & GENERAL AGENT FEES
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 7
Insurance contract or identification number247F1GL28
Number of Individuals Covered898
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $272,473
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $11,856,024
Commission paid to Insurance BrokerUSD $272,473
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 6
Insurance contract or identification number00417347
Number of Individuals Covered956
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,660
Total amount of fees paid to insurance companyUSD $3,643
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $532,800
Commission paid to Insurance BrokerUSD $2,660
Amount paid for insurance broker fees3643
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD382009511801
Policy instance 5
Insurance contract or identification numberGD382009511801
Number of Individuals Covered1349
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $16,362
Total amount of fees paid to insurance companyUSD $6,598
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $161,393
Commission paid to Insurance BrokerUSD $16,362
Amount paid for insurance broker fees6598
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & GENERAL AGENT FEES
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF382009511801
Policy instance 4
Insurance contract or identification numberGF382009511801
Number of Individuals Covered1349
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $20,587
Total amount of fees paid to insurance companyUSD $9,480
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $211,417
Commission paid to Insurance BrokerUSD $20,587
Amount paid for insurance broker fees9480
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & GENERAL AGENT FEES
Insurance broker organization code?3
EYE MED (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10193671001
Policy instance 3
Insurance contract or identification number10193671001
Number of Individuals Covered1003
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $670
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,655
Commission paid to Insurance BrokerUSD $670
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number
Policy instance 2
Number of Individuals Covered957
Insurance policy start date2018-03-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $5,318
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,176
Commission paid to Insurance BrokerUSD $3,191
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number411179
Policy instance 1
Insurance contract or identification number411179
Number of Individuals Covered1302
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $2,973
Total amount of fees paid to insurance companyUSD $438
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $23,446
Commission paid to Insurance BrokerUSD $2,973
Amount paid for insurance broker fees438
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SERV
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD382009511801
Policy instance 2
Insurance contract or identification numberGD382009511801
Number of Individuals Covered1897
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,142
Total amount of fees paid to insurance companyUSD $4,285
Other welfare benefits providedDBL
Welfare Benefit Premiums Paid to CarrierUSD $85,694
Commission paid to Insurance BrokerUSD $5,142
Amount paid for insurance broker fees4285
Additional information about fees paid to insurance brokerOTHER
Insurance broker organization code?3
Insurance broker nameBENEFIT MALL
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number504891
Policy instance 4
Insurance contract or identification number504891
Number of Individuals Covered908
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $6,565
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,647
Commission paid to Insurance BrokerUSD $3,939
Insurance broker organization code?3
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberSA382009511801
Policy instance 3
Insurance contract or identification numberSA382009511801
Number of Individuals Covered1306
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,404
Total amount of fees paid to insurance companyUSD $4,116
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,760
Commission paid to Insurance BrokerUSD $5,404
Amount paid for insurance broker fees4116
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & OTHER
Insurance broker organization code?3
Insurance broker nameBENEFIT MALL
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number000000420991
Policy instance 5
Insurance contract or identification number000000420991
Number of Individuals Covered508
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $21,096
Total amount of fees paid to insurance companyUSD $1,846
Other welfare benefits providedLIFESTYLE LIFE, LIFESTYLE AD&D
Welfare Benefit Premiums Paid to CarrierUSD $93,239
Commission paid to Insurance BrokerUSD $21,096
Amount paid for insurance broker fees1846
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SERV
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD382009511801
Policy instance 6
Insurance contract or identification numberGD382009511801
Number of Individuals Covered1894
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Other welfare benefits providedPAID LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $22,575
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF382009511801
Policy instance 7
Insurance contract or identification numberGF382009511801
Number of Individuals Covered1306
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,138
Total amount of fees paid to insurance companyUSD $5,297
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,789
Commission paid to Insurance BrokerUSD $5,138
Amount paid for insurance broker fees5297
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & OTHER
Insurance broker organization code?3
Insurance broker nameBENEFIT MALL
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGD382009511801
Policy instance 9
Insurance contract or identification numberGD382009511801
Number of Individuals Covered1306
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $4,568
Total amount of fees paid to insurance companyUSD $3,404
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $52,563
Commission paid to Insurance BrokerUSD $4,568
Amount paid for insurance broker fees3404
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION & OTHER
Insurance broker organization code?3
Insurance broker nameBENEFIT MALL
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 11
Insurance contract or identification number00417347
Number of Individuals Covered905
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $25,271
Total amount of fees paid to insurance companyUSD $3,811
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $505,413
Commission paid to Insurance BrokerUSD $25,271
Amount paid for insurance broker fees3811
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 12
Insurance contract or identification number247F1GL28
Number of Individuals Covered874
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $259,319
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $10,418,244
Commission paid to Insurance BrokerUSD $259,319
Insurance broker organization code?3
Insurance broker nameDKG INSURANCE & FINANCIAL SERVICES
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182086
Policy instance 11
Insurance contract or identification number000010182086
Number of Individuals Covered57
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $1,245
Total amount of fees paid to insurance companyUSD $1,333
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $14,915
Amount paid for insurance broker fees1333
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $747
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract numberL00738
Policy instance 7
Insurance contract or identification numberL00738
Number of Individuals Covered1463
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $3,056
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEXEC DBL
Welfare Benefit Premiums Paid to CarrierUSD $144,028
Commission paid to Insurance BrokerUSD $3,056
Insurance broker organization code?3
Insurance broker nameEDWARD P. LEVINS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010184788
Policy instance 9
Insurance contract or identification number000010184788
Number of Individuals Covered1047
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $1,263
Total amount of fees paid to insurance companyUSD $1,701
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $17,094
Amount paid for insurance broker fees1701
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $758
Insurance broker nameCORPORATE HEALTH INNOVIATIONS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number000000420991
Policy instance 8
Insurance contract or identification number000000420991
Number of Individuals Covered520
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Other welfare benefits providedLIFESTYLE LIFE, LIFESTYLE AD&D
Welfare Benefit Premiums Paid to CarrierUSD $43,414
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 14
Insurance contract or identification number247F1GL28
Number of Individuals Covered550
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $232,681
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $8,949,265
Commission paid to Insurance BrokerUSD $232,681
Insurance broker organization code?3
Insurance broker nameDKG INSURANCE & FINANCIAL SERVICES
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182089
Policy instance 12
Insurance contract or identification number000010182089
Number of Individuals Covered1050
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $1,305
Total amount of fees paid to insurance companyUSD $6,397
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $66,960
Commission paid to Insurance BrokerUSD $783
Insurance broker organization code?3
Amount paid for insurance broker fees6397
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker nameCENTERSTONE INS & FNCL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number411179
Policy instance 1
Insurance contract or identification number411179
Number of Individuals Covered1224
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $1,195
Total amount of fees paid to insurance companyUSD $199
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,431
Commission paid to Insurance BrokerUSD $1,195
Amount paid for insurance broker fees199
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INSURANCE AND FINANCE
THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 )
Policy contract numberJ946E0
Policy instance 6
Insurance contract or identification numberJ946E0
Number of Individuals Covered1174
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $10,149
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $101,490
Commission paid to Insurance BrokerUSD $2,537
Insurance broker organization code?3
Insurance broker nameCORPORATE HEALTH INN
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182087
Policy instance 5
Insurance contract or identification number000010182087
Number of Individuals Covered1051
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $1,286
Total amount of fees paid to insurance companyUSD $9,681
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,024
Amount paid for insurance broker fees9681
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $772
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000400182088
Policy instance 4
Insurance contract or identification number000400182088
Number of Individuals Covered482
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $11,329
Total amount of fees paid to insurance companyUSD $7,403
Other welfare benefits providedVOL CHILD LIFE, VOL SPOUSE LIFE, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $75,528
Amount paid for insurance broker fees7403
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,797
Insurance broker nameCORPORATE HEALTH INNOVATIONS
THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 )
Policy contract numberG280708
Policy instance 3
Insurance contract or identification numberG280708
Number of Individuals Covered1603
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of fees paid to insurance companyUSD $235
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $4,704
Amount paid for insurance broker fees235
Additional information about fees paid to insurance brokerADMINSTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FIN SVCS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number504891
Policy instance 2
Insurance contract or identification number504891
Number of Individuals Covered426
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $4,918
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,175
Commission paid to Insurance BrokerUSD $2,951
Insurance broker organization code?3
Insurance broker nameCORPORATE HEALTH INNOVATIONS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 13
Insurance contract or identification number00417347
Number of Individuals Covered840
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $21,990
Total amount of fees paid to insurance companyUSD $4,968
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $439,800
Commission paid to Insurance BrokerUSD $21,990
Amount paid for insurance broker fees4968
Additional information about fees paid to insurance brokerSPECIAL PRODUCER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract numberL00729
Policy instance 10
Insurance contract or identification numberL00729
Number of Individuals Covered1463
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $389
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedSTAFF DBL
Welfare Benefit Premiums Paid to CarrierUSD $2,844
Commission paid to Insurance BrokerUSD $389
Insurance broker organization code?3
Insurance broker nameEDWARD P LEVINS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010184788
Policy instance 5
Insurance contract or identification number000010184788
Number of Individuals Covered1018
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,283
Total amount of fees paid to insurance companyUSD $2,402
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $24,970
Amount paid for insurance broker fees2402
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,370
Insurance broker nameCORPORATE HEALTH INNOVATIONS
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 8
Insurance contract or identification number247F1GL28
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $201,217
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $7,739,116
Commission paid to Insurance BrokerUSD $201,217
Insurance broker organization code?3
Insurance broker nameDKG INSURANCE & FINANCIAL SERVICES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 7
Insurance contract or identification number00417347
Number of Individuals Covered761
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $20,049
Total amount of fees paid to insurance companyUSD $6,898
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $400,973
Commission paid to Insurance BrokerUSD $20,049
Amount paid for insurance broker fees6898
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182086
Policy instance 4
Insurance contract or identification number000010182086
Number of Individuals Covered59
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $2,198
Total amount of fees paid to insurance companyUSD $2,283
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE, AD & D
Welfare Benefit Premiums Paid to CarrierUSD $23,531
Amount paid for insurance broker fees2283
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,319
Insurance broker nameCORPORATE HEALTH INNOVIATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182087
Policy instance 3
Insurance contract or identification number000010182087
Number of Individuals Covered1024
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $6,232
Total amount of fees paid to insurance companyUSD $13,442
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,373
Amount paid for insurance broker fees13442
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $3,739
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000400182088
Policy instance 2
Insurance contract or identification number000400182088
Number of Individuals Covered463
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $9,113
Total amount of fees paid to insurance companyUSD $10,580
Other welfare benefits providedVOL CHILD LIFE, VOL SPOUSE LIFE, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $109,602
Amount paid for insurance broker fees10580
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,537
Insurance broker nameCORPORATE HEALTH INNOVATIONS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number
Policy instance 1
Number of Individuals Covered511
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,428
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,079
Commission paid to Insurance BrokerUSD $917
Insurance broker organization code?3
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182089
Policy instance 6
Insurance contract or identification number000010182089
Number of Individuals Covered1024
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $4,138
Total amount of fees paid to insurance companyUSD $8,831
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $94,948
Commission paid to Insurance BrokerUSD $2,483
Insurance broker organization code?3
Amount paid for insurance broker fees8831
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker nameCENTERSTONE INS & FNCL SVCS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182087
Policy instance 2
Insurance contract or identification number000010182087
Number of Individuals Covered940
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $3,648
Total amount of fees paid to insurance companyUSD $1,252
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,045
Amount paid for insurance broker fees1252
Additional information about fees paid to insurance brokerOVERRIDES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,189
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182086
Policy instance 3
Insurance contract or identification number000010182086
Number of Individuals Covered61
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $709
Total amount of fees paid to insurance companyUSD $274
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT LIFE, AD & D
Welfare Benefit Premiums Paid to CarrierUSD $5,478
Amount paid for insurance broker fees274
Additional information about fees paid to insurance brokerOVERRIDES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $425
Insurance broker nameCORPORATE HEALTH INNOVIATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010184788
Policy instance 4
Insurance contract or identification number000010184788
Number of Individuals Covered929
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $958
Total amount of fees paid to insurance companyUSD $386
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $7,712
Amount paid for insurance broker fees386
Additional information about fees paid to insurance brokerOVERRIDES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $575
Insurance broker nameCORPORATE HEALTH INNOVATIONS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010182089
Policy instance 5
Insurance contract or identification number000010182089
Number of Individuals Covered940
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $1,855
Total amount of fees paid to insurance companyUSD $777
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $15,531
Commission paid to Insurance BrokerUSD $1,113
Insurance broker organization code?3
Amount paid for insurance broker fees777
Additional information about fees paid to insurance brokerOVERRIDES
Insurance broker nameCENTERSTONE INS & FNCL SVCS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5455-00
Policy instance 7
Insurance contract or identification number454-5455-00
Number of Individuals Covered875
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $12,024
Total amount of fees paid to insurance companyUSD $3,532
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,201
Amount paid for insurance broker fees3532
Additional information about fees paid to insurance brokerBONUS PAID TO PRODUCER FOR PERIOD FROM 1/1/2011 TO 1/1/2012
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $3,126
Insurance broker nameDKG INS & FINANCIAL SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 8
Insurance contract or identification number00417347
Number of Individuals Covered711
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $18,212
Total amount of fees paid to insurance companyUSD $8,153
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $364,246
Commission paid to Insurance BrokerUSD $18,212
Amount paid for insurance broker fees8153
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463249
Policy instance 10
Insurance contract or identification number463249
Number of Individuals Covered49
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDBL
Welfare Benefit Premiums Paid to CarrierUSD $2,052
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number100-4820-00
Policy instance 9
Insurance contract or identification number100-4820-00
Number of Individuals Covered1264
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $9,915
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,512
Commission paid to Insurance BrokerUSD $2,677
Insurance broker organization code?3
Insurance broker nameDKG INS & FINANCIAL SERVICES
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 11
Insurance contract or identification number247F1GL28
Number of Individuals Covered461
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $155,757
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $5,983,720
Commission paid to Insurance BrokerUSD $155,757
Insurance broker organization code?3
Insurance broker nameDKG INSURANCE & FINANCIAL SERVICES
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458497
Policy instance 12
Insurance contract or identification number458497
Number of Individuals Covered49
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $32,998
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458881
Policy instance 13
Insurance contract or identification number458881
Number of Individuals Covered48
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $23,488
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000400182088
Policy instance 1
Insurance contract or identification number000400182088
Number of Individuals Covered418
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $2,702
Total amount of fees paid to insurance companyUSD $1,641
Other welfare benefits providedVOL CHILD LIFE, VOL SPOUSE LIFE, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $32,824
Amount paid for insurance broker fees1641
Additional information about fees paid to insurance brokerOVERRIDES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $733
Insurance broker nameCORPORATE HEALTH INNOVATIONS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463469
Policy instance 6
Insurance contract or identification number463469
Number of Individuals Covered935
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedFLEX AD&D & FLEX LIFE
Welfare Benefit Premiums Paid to CarrierUSD $85,014
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5455-00
Policy instance 2
Insurance contract or identification number454-5455-00
Number of Individuals Covered880
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $20,413
Total amount of fees paid to insurance companyUSD $3,532
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,462
Commission paid to Insurance BrokerUSD $12,310
Amount paid for insurance broker fees3532
Additional information about fees paid to insurance brokerBONUS PAID FOR PERIOD 1/1/11 TO 1/1/12
Insurance broker organization code?3
Insurance broker nameDKG INS & FINANCIAL SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 3
Insurance contract or identification number00417347
Number of Individuals Covered653
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $17,090
Total amount of fees paid to insurance companyUSD $8,040
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $341,800
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees8040
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number100-4820-00
Policy instance 4
Insurance contract or identification number100-4820-00
Number of Individuals Covered1186
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $10,896
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,276
Commission paid to Insurance BrokerUSD $7,624
Insurance broker organization code?3
Insurance broker nameDKG INS & FINANCIAL SERVICES
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463249
Policy instance 5
Insurance contract or identification number463249
Number of Individuals Covered49
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $178
Total amount of fees paid to insurance companyUSD $10
Other welfare benefits providedDBL
Welfare Benefit Premiums Paid to CarrierUSD $2,888
Commission paid to Insurance BrokerUSD $178
Amount paid for insurance broker fees10
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number247F1GL28
Policy instance 6
Insurance contract or identification number247F1GL28
Number of Individuals Covered604
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $114,383
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPOS CONTRACT - COMPREHENSIVE MEDICAL AND SURGICAL
Welfare Benefit Premiums Paid to CarrierUSD $4,399,372
Commission paid to Insurance BrokerUSD $114,383
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCI22890
Policy instance 7
Insurance contract or identification numberCI22890
Number of Individuals Covered935
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $30,382
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $407,853
Commission paid to Insurance BrokerUSD $30,382
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458881
Policy instance 9
Insurance contract or identification number458881
Number of Individuals Covered49
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $1,017
Total amount of fees paid to insurance companyUSD $101
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $30,556
Commission paid to Insurance BrokerUSD $1,017
Amount paid for insurance broker fees101
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458497
Policy instance 8
Insurance contract or identification number458497
Number of Individuals Covered49
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $2,145
Total amount of fees paid to insurance companyUSD $158
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $47,457
Commission paid to Insurance BrokerUSD $2,145
Amount paid for insurance broker fees158
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463469
Policy instance 1
Insurance contract or identification number463469
Number of Individuals Covered922
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $1,758
Total amount of fees paid to insurance companyUSD $378
Other welfare benefits providedFLEX AD&D & FLEX LIFE
Welfare Benefit Premiums Paid to CarrierUSD $121,808
Commission paid to Insurance BrokerUSD $1,758
Amount paid for insurance broker fees378
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 3
Insurance contract or identification number00417347
Number of Individuals Covered635
Insurance policy start date2011-03-01
Total amount of commissions paid to insurance brokerUSD $34,462
Total amount of fees paid to insurance companyUSD $6,097
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $313,291
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458881
Policy instance 9
Insurance contract or identification number458881
Number of Individuals Covered43
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $2,840
Total amount of fees paid to insurance companyUSD $164
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $31,421
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458497
Policy instance 8
Insurance contract or identification number458497
Number of Individuals Covered43
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $5,457
Total amount of fees paid to insurance companyUSD $236
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $47,681
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCI22890
Policy instance 7
Insurance contract or identification numberCI22890
Number of Individuals Covered902
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $94,869
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,411,986
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number100284E 000
Policy instance 6
Insurance contract or identification number100284E 000
Number of Individuals Covered290
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $311
Other welfare benefits providedPOS CONTRACT - COMPREHENSIVE MEDICAL AND SURGICAL
Welfare Benefit Premiums Paid to CarrierUSD $194,166
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number459389
Policy instance 5
Insurance contract or identification number459389
Number of Individuals Covered259
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $10,502
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $535,683
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number100-4820-00
Policy instance 4
Insurance contract or identification number100-4820-00
Number of Individuals Covered1068
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $8,110
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,137
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5455-00
Policy instance 2
Insurance contract or identification number454-5455-00
Number of Individuals Covered811
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $13,632
Total amount of fees paid to insurance companyUSD $317
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,359
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463469
Policy instance 1
Insurance contract or identification number463469
Number of Individuals Covered853
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $5,022
Total amount of fees paid to insurance companyUSD $577
Other welfare benefits providedFLEX AD&D & FLEX LIFE
Welfare Benefit Premiums Paid to CarrierUSD $107,130
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5455-00
Policy instance 10
Insurance contract or identification number454-5455-00
Number of Individuals Covered781
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $16,466
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 $145,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,320
Insurance broker organization code?3
Insurance broker nameBENEFITS WEB COM, INC.
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458881
Policy instance 9
Insurance contract or identification number458881
Number of Individuals Covered37
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,416
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 BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $29,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,208
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES,INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00417347
Policy instance 7
Insurance contract or identification number00417347
Number of Individuals Covered536
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $16,632
Total amount of fees paid to insurance companyUSD $10,988
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $277,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,632
Amount paid for insurance broker fees10988
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP PLANS, INC.
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463249
Policy instance 4
Insurance contract or identification number463249
Number of Individuals Covered37
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $434
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $217
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES, INC.
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number100284E 000
Policy instance 8
Insurance contract or identification number100284E 000
Number of Individuals Covered415
Insurance policy start date2010-11-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $19,434
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $978,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,717
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number459389
Policy instance 1
Insurance contract or identification number459389
Number of Individuals Covered27
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $20,862
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $326,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,852
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES, INC.
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number463469
Policy instance 5
Insurance contract or identification number463469
Number of Individuals Covered772
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,908
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 BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $95,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,954
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES, INC.
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract numberUS104144
Policy instance 2
Insurance contract or identification numberUS104144
Number of Individuals Covered541
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $115,714
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,591,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,323
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP PLANS
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number458497
Policy instance 3
Insurance contract or identification number458497
Number of Individuals Covered37
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,654
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 $42,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,327
Insurance broker organization code?3
Insurance broker nameJIMCO ASSOCIATES,INC.
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number100-4820-00
Policy instance 6
Insurance contract or identification number100-4820-00
Number of Individuals Covered1122
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,585
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $88,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,585
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP PLANS

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