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NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 401k Plan overview

Plan NameNATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
Plan identification number 502

NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NATIONAL AUDUBON SOCIETY, INC. has sponsored the creation of one or more 401k plans.

Company Name:NATIONAL AUDUBON SOCIETY, INC.
Employer identification number (EIN):131624102
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about NATIONAL AUDUBON SOCIETY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1970-01-27
Company Identification Number: 0002997707
Legal Registered Office Address: 225 VARICK ST FL 7

NEW YORK
United States of America (USA)
10014

More information about NATIONAL AUDUBON SOCIETY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01MARY BETH HENSON
5022017-01-01MARY BETH HENSON
5022016-01-01MARY BETH HENSON
5022015-01-01MARY BETH HENSON MARY BETH HENSON2016-07-25
5022014-01-01MARY BETH HENSON MARY BETH HENSON2015-07-28
5022013-01-01MARY BETH HENSON
5022012-01-01MARY BETH HENSON MARY BETH HENSON2013-06-21
5022011-01-01PATRICIA DOUGLAS PATRICIA DOUGLAS2012-08-16
5022010-01-01PATRICIA DOUGLAS
5022009-01-01PATRICIA DOUGLAS PATRICIA DOUGLAS2010-08-18

Plan Statistics for NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

401k plan membership statisitcs for NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Measure Date Value
2022: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01623
Total number of active participants reported on line 7a of the Form 55002022-01-01638
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01638
2021: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01602
Total number of active participants reported on line 7a of the Form 55002021-01-01621
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01621
2020: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01650
Total number of active participants reported on line 7a of the Form 55002020-01-01601
Number of retired or separated participants receiving benefits2020-01-0125
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01626
2019: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01600
Total number of active participants reported on line 7a of the Form 55002019-01-01618
Number of retired or separated participants receiving benefits2019-01-0126
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01644
2018: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01547
Total number of active participants reported on line 7a of the Form 55002018-01-01570
Number of retired or separated participants receiving benefits2018-01-0129
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01599
2017: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01545
Total number of active participants reported on line 7a of the Form 55002017-01-01519
Number of retired or separated participants receiving benefits2017-01-0132
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01551
2016: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01532
Total number of active participants reported on line 7a of the Form 55002016-01-01521
Number of retired or separated participants receiving benefits2016-01-0133
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01554
2015: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01514
Total number of active participants reported on line 7a of the Form 55002015-01-01494
Number of retired or separated participants receiving benefits2015-01-0134
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01528
2014: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01499
Total number of active participants reported on line 7a of the Form 55002014-01-01480
Number of retired or separated participants receiving benefits2014-01-0136
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01516
2013: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01473
Total number of active participants reported on line 7a of the Form 55002013-01-01463
Number of retired or separated participants receiving benefits2013-01-0139
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01502
2012: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01611
Total number of active participants reported on line 7a of the Form 55002012-01-01476
Number of retired or separated participants receiving benefits2012-01-0142
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01518
2011: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01589
Total number of active participants reported on line 7a of the Form 55002011-01-01521
Number of retired or separated participants receiving benefits2011-01-0146
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01567
2010: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01592
Total number of active participants reported on line 7a of the Form 55002010-01-01545
Number of retired or separated participants receiving benefits2010-01-0152
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01597
2009: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01624
Total number of active participants reported on line 7a of the Form 55002009-01-01529
Number of retired or separated participants receiving benefits2009-01-0153
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01582

Form 5500 Responses for NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

2022: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: NATIONAL AUDUBON SOCIETY, INC. EMPLOYEES GROUP LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered623
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,323
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $211,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5323
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered601
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,896
Total amount of fees paid to insurance companyUSD $3,160
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $236,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3160
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,896
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered625
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $21,064
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $210,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,064
Insurance broker organization code?3
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered571
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $18,025
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $180,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,811
Insurance broker organization code?3
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered514
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,656
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $156,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,656
Insurance broker organization code?3
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered512
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,121
Total amount of fees paid to insurance companyUSD $1,836
Are there contracts with allocated funds for individual policies?0
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $131,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,121
Amount paid for insurance broker fees1836
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK INC.
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )
Policy contract numberGL153197*
Policy instance 1
Insurance contract or identification numberGL153197*
Number of Individuals Covered484
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,926
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $109,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,926
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43754
Policy instance 1
Insurance contract or identification number43754
Number of Individuals Covered516
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,543
Total amount of fees paid to insurance companyUSD $678
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $212,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,543
Insurance broker organization code?3
Amount paid for insurance broker fees678
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker nameWILLIS INSURANCE SERVICES OF CA INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43754
Policy instance 1
Insurance contract or identification number43754
Number of Individuals Covered517
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $19,381
Total amount of fees paid to insurance companyUSD $1,457
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $193,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,381
Insurance broker organization code?3
Amount paid for insurance broker fees1457
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker nameWILLIS INSURANCE SERVICES OF CA INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43754
Policy instance 1
Insurance contract or identification number43754
Number of Individuals Covered563
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $18,872
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $188,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number43754
Policy instance 1
Insurance contract or identification number43754
Number of Individuals Covered561
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $20,038
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $200,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,038
Insurance broker organization code?3
Insurance broker nameWILLIS CORROON CORP OF NEW YORK

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