ARROWOOD INDEMNITY COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY
401k plan membership statisitcs for THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY
| Measure | Date | Value |
|---|
| 2022: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 587 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 138 |
| Total of all active and inactive participants | 2022-01-01 | 138 |
| Total participants | 2022-01-01 | 138 |
| 2021: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 602 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 587 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 587 |
| Total participants | 2021-01-01 | 587 |
| 2020: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,526 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 602 |
| Total of all active and inactive participants | 2020-01-01 | 602 |
| Total participants | 2020-01-01 | 602 |
| 2019: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,709 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 1,526 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 1,526 |
| Total participants | 2019-01-01 | 1,526 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 102 |
| Number of participants with account balances | 2019-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 0 |
| 2018: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,807 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 1,661 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 1,661 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 48 |
| Total participants | 2018-01-01 | 1,709 |
| 2017: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,890 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1,757 |
| Total of all active and inactive participants | 2017-01-01 | 1,757 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 50 |
| Total participants | 2017-01-01 | 1,807 |
| 2016: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,986 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1,841 |
| Total of all active and inactive participants | 2016-01-01 | 1,841 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 49 |
| Total participants | 2016-01-01 | 1,890 |
| 2015: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 2,097 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 1,938 |
| Total of all active and inactive participants | 2015-01-01 | 1,938 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 48 |
| Total participants | 2015-01-01 | 1,986 |
| 2014: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 2,268 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 2,055 |
| Total of all active and inactive participants | 2014-01-01 | 2,055 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 42 |
| Total participants | 2014-01-01 | 2,097 |
| 2013: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 2,271 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 2,230 |
| Total of all active and inactive participants | 2013-01-01 | 2,230 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 38 |
| Total participants | 2013-01-01 | 2,268 |
| 2012: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 2,220 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 2,241 |
| Total of all active and inactive participants | 2012-01-01 | 2,241 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 30 |
| Total participants | 2012-01-01 | 2,271 |
| 2011: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 1,256 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 2,181 |
| Total of all active and inactive participants | 2011-01-01 | 2,181 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 39 |
| Total participants | 2011-01-01 | 2,220 |
| 2010: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 425 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 1,256 |
| Total of all active and inactive participants | 2010-01-01 | 1,256 |
| Total participants | 2010-01-01 | 1,256 |
| 2022: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: THE FORMER EMPLOYEE HEALTH & WELFARE BENEFIT PLAN OF ARROWOOD INDEMNITY COMPANY 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | First time form 5500 has been submitted | Yes |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 4311 4312 |
| Policy instance | 3 |
| Insurance contract or identification number | 4311 4312 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,408 | | Welfare Benefit Premiums Paid to Carrier | USD $208,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,408 | | Insurance broker organization code? | 5 |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | 12348 |
| Policy instance | 2 |
| Insurance contract or identification number | 12348 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $184,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00617017 |
| Policy instance | 1 |
| Insurance contract or identification number | 00617017 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00617017 |
| Policy instance | 1 |
| Insurance contract or identification number | 00617017 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 3403 & 3404 |
| Policy instance | 2 |
| Insurance contract or identification number | 3403 & 3404 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $67,264 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $435,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,264 | | Insurance broker organization code? | 5 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 4311 4312 |
| Policy instance | 3 |
| Insurance contract or identification number | 4311 4312 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,926 | | Welfare Benefit Premiums Paid to Carrier | USD $234,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,926 | | Insurance broker organization code? | 5 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 4311 4312 |
| Policy instance | 3 |
| Insurance contract or identification number | 4311 4312 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,949 | | Welfare Benefit Premiums Paid to Carrier | USD $270,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,949 | | Insurance broker organization code? | 5 |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 3403 & 3404 |
| Policy instance | 2 |
| Insurance contract or identification number | 3403 & 3404 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $71,490 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $478,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,490 | | Insurance broker organization code? | 5 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00617017 |
| Policy instance | 1 |
| Insurance contract or identification number | 00617017 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0154858 |
| Policy instance | 4 |
| Insurance contract or identification number | 0154858 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,267 | | Total amount of fees paid to insurance company | USD $2,976 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,538,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,267 | | Amount paid for insurance broker fees | 2976 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00617017 |
| Policy instance | 1 |
| Insurance contract or identification number | 00617017 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 4311 4312 |
| Policy instance | 3 |
| Insurance contract or identification number | 4311 4312 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,371 | | Welfare Benefit Premiums Paid to Carrier | USD $288,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,371 | | Insurance broker organization code? | 5 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0154858 |
| Policy instance | 4 |
| Insurance contract or identification number | 0154858 | | Number of Individuals Covered | 1350 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $9,274 | | Total amount of fees paid to insurance company | USD $17,996 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,382,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,274 | | Amount paid for insurance broker fees | 17996 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 3403 & 3404 |
| Policy instance | 2 |
| Insurance contract or identification number | 3403 & 3404 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $78,942 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $528,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $78,942 | | Insurance broker organization code? | 5 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0154858 |
| Policy instance | 4 |
| Insurance contract or identification number | 0154858 | | Number of Individuals Covered | 1481 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,543 | | Total amount of fees paid to insurance company | USD $28,639 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,219,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,543 | | Amount paid for insurance broker fees | 28639 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | TRION GROUP |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D3403 & D3404 |
| Policy instance | 3 |
| Insurance contract or identification number | D3403 & D3404 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $16,587 | | Welfare Benefit Premiums Paid to Carrier | USD $329,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,587 | | Insurance broker organization code? | 5 | | Insurance broker name | AMWINS |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 3403 & 3404 |
| Policy instance | 2 |
| Insurance contract or identification number | 3403 & 3404 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $93,848 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $628,057 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $93,848 | | Insurance broker organization code? | 5 | | Insurance broker name | AMWINS |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00617017 |
| Policy instance | 1 |
| Insurance contract or identification number | 00617017 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $158,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 081019 |
| Policy instance | 1 |
| Insurance contract or identification number | 081019 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $157 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $230,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 157 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EDMUND F GARNO III |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 3403 & 3404 |
| Policy instance | 2 |
| Insurance contract or identification number | 3403 & 3404 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $108,516 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $726,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $107,799 | | Insurance broker organization code? | 5 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D3403 & D3404 |
| Policy instance | 3 |
| Insurance contract or identification number | D3403 & D3404 | | Number of Individuals Covered | 413 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $19,169 | | Welfare Benefit Premiums Paid to Carrier | USD $364,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,839 | | Insurance broker organization code? | 5 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 4 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0154858 |
| Policy instance | 5 |
| Insurance contract or identification number | 0154858 | | Number of Individuals Covered | 1629 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $13,596 | | Total amount of fees paid to insurance company | USD $17,701 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,391,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,596 | | Amount paid for insurance broker fees | 17701 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | TRION GROUP |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0154858 |
| Policy instance | 6 |
| Insurance contract or identification number | 0154858 | | Number of Individuals Covered | 1719 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $28,867 | | Total amount of fees paid to insurance company | USD $17,487 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,445,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,867 | | Amount paid for insurance broker fees | 17487 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 5 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | 4802 |
| Policy instance | 4 |
| Insurance contract or identification number | 4802 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $50,870 | | Welfare Benefit Premiums Paid to Carrier | USD $465,531 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,843 | | Insurance broker organization code? | 5 | | Insurance broker name | WELLS FARGO NSURANCE SERVICES |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | M2092555H LIST |
| Policy instance | 3 |
| Insurance contract or identification number | M2092555H LIST | | Number of Individuals Covered | 435 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $181,326 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $826,038 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135,731 | | Insurance broker organization code? | 5 | | Insurance broker name | WEB TPA |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335194 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335194 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 228543 |
| Policy instance | 1 |
| Insurance contract or identification number | 228543 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $760,171 | | 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 number | FLX051668 |
| Policy instance | 6 |
| Insurance contract or identification number | FLX051668 | | Number of Individuals Covered | 1763 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $70,041 | | Total amount of fees paid to insurance company | USD $-31,490 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,323,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,041 | | Amount paid for insurance broker fees | -31490 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 5 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | S 4802 |
| Policy instance | 4 |
| Insurance contract or identification number | S 4802 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $87,529 | | Welfare Benefit Premiums Paid to Carrier | USD $860,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,152 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 228543 |
| Policy instance | 1 |
| Insurance contract or identification number | 228543 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $918,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0925555H LIST |
| Policy instance | 3 |
| Insurance contract or identification number | MZ0925555H LIST | | Number of Individuals Covered | 496 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $191,197 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $871,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $140,267 | | Insurance broker name | WEB TPA |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335194 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335194 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,103 | | 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 number | FLX051668 |
| Policy instance | 6 |
| Insurance contract or identification number | FLX051668 | | Number of Individuals Covered | 1828 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $10,684 | | Total amount of fees paid to insurance company | USD $31,503 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,369,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,684 | | Amount paid for insurance broker fees | 31503 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 5 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | S 4802 |
| Policy instance | 4 |
| Insurance contract or identification number | S 4802 | | Number of Individuals Covered | 528 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $115,156 | | Welfare Benefit Premiums Paid to Carrier | USD $985,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108,027 | | Insurance broker organization code? | 5 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0925555H LIST |
| Policy instance | 3 |
| Insurance contract or identification number | MZ0925555H LIST | | Number of Individuals Covered | 540 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $198,345 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $903,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $142,141 | | Insurance broker organization code? | 5 | | Insurance broker name | WEB TPA |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3335194 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335194 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 228543 |
| Policy instance | 1 |
| Insurance contract or identification number | 228543 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,139,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | S 4802 |
| Policy instance | 3 |
| Insurance contract or identification number | S 4802 | | Number of Individuals Covered | 612 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $108,366 | | Welfare Benefit Premiums Paid to Carrier | USD $1,088,756 | | 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 number | FLX051668 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX051668 | | Number of Individuals Covered | 1886 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $59,661 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,380,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 228543 |
| Policy instance | 1 |
| Insurance contract or identification number | 228543 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,286,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0925555H LIST |
| Policy instance | 2 |
| Insurance contract or identification number | MZ0925555H LIST | | Number of Individuals Covered | 625 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $213,996 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $978,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 4 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9771825 |
| Policy instance | 4 |
| Insurance contract or identification number | 9771825 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $905 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0925555H LIST |
| Policy instance | 2 |
| Insurance contract or identification number | MZ0925555H LIST | | Number of Individuals Covered | 742 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $231,100 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,056,348 | | Commission paid to Insurance Broker | USD $134,096 | | Insurance broker organization code? | 3 | | Insurance broker name | WEB TPA |
|
| STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | S 4802 |
| Policy instance | 3 |
| Insurance contract or identification number | S 4802 | | Number of Individuals Covered | 678 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $122,246 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,087,501 | | Commission paid to Insurance Broker | USD $101,374 | | Insurance broker organization code? | 3 | | Insurance broker name | WACHOVIA INSURANCE SERVICES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 228543 |
| Policy instance | 1 |
| Insurance contract or identification number | 228543 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,299,781 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003718/3719 |
| Policy instance | 5 |
| Insurance contract or identification number | AGP-003718/3719 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $-2,183 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $-7,606 | | Commission paid to Insurance Broker | USD $-268 | | Insurance broker organization code? | 3 | | Insurance broker name | NEBCO |
|
