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PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 401k Plan overview

Plan NamePHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES
Plan identification number 502

PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental

401k Sponsoring company profile

PHILIPS NORTH AMERICA LLC has sponsored the creation of one or more 401k plans.

Company Name:PHILIPS NORTH AMERICA LLC
Employer identification number (EIN):133429115
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01KRISTINE FORTIN2023-10-09 KRISTINE FORTIN2023-10-09
5022021-01-01KRISTINE FORTIN2022-10-12 KRISTINE FORTIN2022-10-12
5022020-01-01KRISTINE FORTIN2021-10-07 KRISTINE FORTIN2021-10-07
5022019-01-01KRISTINE FORTIN2020-10-07 KRISTINE FORTIN2020-10-07
5022017-01-01
5022016-01-01
5022015-01-01KRISTINE FORTIN
5022014-01-01LEVERDA WALLACE
5022013-01-01JULIE THIBODEAU
5022012-01-01ELIZABETH A. GRELLA
5022011-01-01ELIZABETH A. GRELLA
5022010-01-01ELIZABETH A GRELLA

Plan Statistics for PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES

401k plan membership statisitcs for PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES

Measure Date Value
2022: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2022 401k membership
Total participants, beginning-of-year2022-01-011,628
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-011,385
Number of other retired or separated participants entitled to future benefits2022-01-017
Total of all active and inactive participants2022-01-011,392
2021: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2021 401k membership
Total participants, beginning-of-year2021-01-012,389
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-013,132
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-013,144
2020: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2020 401k membership
Total participants, beginning-of-year2020-01-012,618
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-012,325
Number of other retired or separated participants entitled to future benefits2020-01-0164
Total of all active and inactive participants2020-01-012,389
2019: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2019 401k membership
Total participants, beginning-of-year2019-01-012,343
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-011,244
Number of other retired or separated participants entitled to future benefits2019-01-01564
Total of all active and inactive participants2019-01-011,808
2017: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2017 401k membership
Total participants, beginning-of-year2017-01-013,040
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-011,822
Number of other retired or separated participants entitled to future benefits2017-01-01416
Total of all active and inactive participants2017-01-012,238
2016: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2016 401k membership
Total participants, beginning-of-year2016-01-013,367
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-012,612
Number of other retired or separated participants entitled to future benefits2016-01-01428
Total of all active and inactive participants2016-01-013,040
2015: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2015 401k membership
Total participants, beginning-of-year2015-01-014,137
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-014,432
Number of other retired or separated participants entitled to future benefits2015-01-01639
Total of all active and inactive participants2015-01-015,071
2014: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2014 401k membership
Total participants, beginning-of-year2014-01-014,137
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-013,344
Number of other retired or separated participants entitled to future benefits2014-01-01941
Total of all active and inactive participants2014-01-014,285
2013: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2013 401k membership
Total participants, beginning-of-year2013-01-014,134
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-013,325
Number of other retired or separated participants entitled to future benefits2013-01-01812
Total of all active and inactive participants2013-01-014,137
2012: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2012 401k membership
Total participants, beginning-of-year2012-01-015,364
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-014,487
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-014,487
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-01824
2011: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2011 401k membership
Total participants, beginning-of-year2011-01-016,258
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-016,331
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-016,331
2010: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2010 401k membership
Total participants, beginning-of-year2010-01-017,688
Total number of active participants reported on line 7a of the Form 55002010-01-010
Number of retired or separated participants receiving benefits2010-01-016,258
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-016,258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-01936

Form 5500 Responses for PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES

2022: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 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 funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: PHILIPS ELECTRONICS NORTH AMERICA CORPORATION WELFARE BENEFIT PLAN FOR RETIREES 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Submission has been amendedYes
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 funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number70737
Policy instance 1
Insurance contract or identification number70737
Number of Individuals Covered1392
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,513
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
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 $560,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,513
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number221344
Policy instance 1
Insurance contract or identification number221344
Number of Individuals Covered3144
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,139
Total amount of fees paid to insurance companyUSD $1,221
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 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 $1,145,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,139
Insurance broker organization code?3
Amount paid for insurance broker fees1221
Additional information about fees paid to insurance brokerBONUSES AND ADDITIONAL PAYMENTS
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number221344
Policy instance 1
Insurance contract or identification number221344
Number of Individuals Covered2389
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,026
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 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 $834,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,026
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number221344
Policy instance 1
Insurance contract or identification number221344
Number of Individuals Covered1808
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $11,012
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 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 $788,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,046
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number221344
Policy instance 1
Insurance contract or identification number221344
Number of Individuals Covered23200
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $95,306
Total amount of fees paid to insurance companyUSD $22,500
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 providedAD&D
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 $8,694,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,306
Insurance broker organization code?3
Amount paid for insurance broker fees22500
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameINTEGRO USA INC DBA INTEGRO
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX980001
Policy instance 1
Insurance contract or identification numberFLX980001
Number of Individuals Covered3147
Insurance policy start date2012-01-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $21,045
Total amount of fees paid to insurance companyUSD $12,650
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 $972,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,045
Amount paid for insurance broker fees12650
Additional information about fees paid to insurance brokerSUPP. COMMISION & OVERRIDE
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY L
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX980001
Policy instance 1
Insurance contract or identification numberFLX980001
Number of Individuals Covered3281
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $164,730
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 $3,091,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX980001
Policy instance 1
Insurance contract or identification numberFLX980001
Number of Individuals Covered1197
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,057
Total amount of fees paid to insurance companyUSD $30,511
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 $842,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,057
Amount paid for insurance broker fees30511
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameTRION GROUP INC

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