ADMINISTRATION SERVICES INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ADMINISTRATION SERVICES INC HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2021: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 95 |
| Total of all active and inactive participants | 2021-12-01 | 95 |
| 2020: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 108 |
| Total of all active and inactive participants | 2020-12-01 | 108 |
| 2019: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 101 |
| Total of all active and inactive participants | 2019-12-01 | 101 |
| 2018: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 130 |
| Total of all active and inactive participants | 2018-12-01 | 130 |
| 2017: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 162 |
| Total of all active and inactive participants | 2017-12-01 | 162 |
| 2016: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 148 |
| Total of all active and inactive participants | 2016-12-01 | 148 |
| 2015: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 121 |
| Total of all active and inactive participants | 2015-12-01 | 121 |
| 2014: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 110 |
| Total of all active and inactive participants | 2014-12-01 | 110 |
| 2013: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 129 |
| Total of all active and inactive participants | 2013-12-01 | 129 |
| 2012: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 114 |
| Total of all active and inactive participants | 2012-12-01 | 114 |
| 2011: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 114 |
| Total of all active and inactive participants | 2011-12-01 | 114 |
| 2009: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 122 |
| Total of all active and inactive participants | 2009-12-01 | 122 |
| 2021: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ADMINISTRATION SERVICES INC HEALTH CARE PLAN 2009 form 5500 responses |
|---|
| 2009-12-01 | Type of plan entity | Single employer plan |
| 2009-12-01 | This submission is the final filing | No |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00544126 |
| Policy instance | 2 |
| Insurance contract or identification number | 00544126 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $13,111 | | Total amount of fees paid to insurance company | USD $3,685 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $94,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,714 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3685 | | Additional information about fees paid to insurance broker | AGENCY FEES |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | CMG-10545-21-L |
| Policy instance | 1 |
| Insurance contract or identification number | CMG-10545-21-L | | Number of Individuals Covered | 160 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $27,597 | | Total amount of fees paid to insurance company | USD $72,144 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $334,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 39754 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $27,597 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00544126 |
| Policy instance | 2 |
| Insurance contract or identification number | 00544126 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $7,799 | | Total amount of fees paid to insurance company | USD $5,307 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $84,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,799 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5307 | | Additional information about fees paid to insurance broker | AGENCY FEES |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | CMG-10545-20 |
| Policy instance | 1 |
| Insurance contract or identification number | CMG-10545-20 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $28,287 | | Total amount of fees paid to insurance company | USD $67,061 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $321,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 38813 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $28,287 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | CMG-10545-20 |
| Policy instance | 1 |
| Insurance contract or identification number | CMG-10545-20 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $27,532 | | Total amount of fees paid to insurance company | USD $66,486 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $313,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 38365 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $27,532 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00544126 |
| Policy instance | 2 |
| Insurance contract or identification number | 00544126 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $7,596 | | Total amount of fees paid to insurance company | USD $2,049 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $82,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,596 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2049 | | Additional information about fees paid to insurance broker | AGENCY FEES |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US598647-18 |
| Policy instance | 1 |
| Insurance contract or identification number | US598647-18 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $38,763 | | Total amount of fees paid to insurance company | USD $89,629 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $475,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 51060 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $38,763 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00544126 |
| Policy instance | 2 |
| Insurance contract or identification number | 00544126 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $8,561 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $108,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,561 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00544126 |
| Policy instance | 2 |
| Insurance contract or identification number | 00544126 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $7,692 | | Total amount of fees paid to insurance company | USD $402 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $104,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMFIRST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60250 ) |
| Policy contract number | 13099 |
| Policy instance | 1 |
| Insurance contract or identification number | 13099 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $13,140 | | Total amount of fees paid to insurance company | USD $524,017 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $105,114 | | 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 | TM05996863 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05996863 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2016-11-30 | | Total amount of commissions paid to insurance broker | USD $6,776 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $75,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,776 | | Insurance broker organization code? | 3 | | Insurance broker name | GARLOW INSURANCE AGENCY |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | 13099 |
| Policy instance | 1 |
| Insurance contract or identification number | 13099 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2016-11-30 | | Total amount of commissions paid to insurance broker | USD $10,790 | | Total amount of fees paid to insurance company | USD $384,255 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 285212 | | Additional information about fees paid to insurance broker | STOP-LOSS PREMIUM | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $7,193 | | Insurance broker name | MWL |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05996863 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05996863 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $7,482 | | Total amount of fees paid to insurance company | USD $276 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $86,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,482 | | Amount paid for insurance broker fees | 276 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GARLOW INSURANCE AGENCY |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | PREMIUM SAVER |
| Policy instance | 2 |
| Insurance contract or identification number | PREMIUM SAVER | | Number of Individuals Covered | 100 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $12,828 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICAL SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $85,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,903 | | Insurance broker organization code? | 3 | | Insurance broker name | RYAN FITZER |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 09102580 |
| Policy instance | 1 |
| Insurance contract or identification number | 09102580 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $35,622 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $920,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,278 | | Insurance broker organization code? | 3 | | Insurance broker name | JACK GRIMM |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05996863 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05996863 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $6,129 | | Total amount of fees paid to insurance company | USD $1,102 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $75,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,129 | | Amount paid for insurance broker fees | 1102 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GARLOW INSURANCE AGENCY |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | PREMIUM SAVER |
| Policy instance | 2 |
| Insurance contract or identification number | PREMIUM SAVER | | Number of Individuals Covered | 120 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $11,454 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICAL SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $76,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,637 | | Insurance broker name | MWL |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 09102580 |
| Policy instance | 1 |
| Insurance contract or identification number | 09102580 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $26,234 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $670,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,234 | | Insurance broker name | CAROL A LOEW |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 8044520000 |
| Policy instance | 1 |
| Insurance contract or identification number | 8044520000 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $17,651 | | Total amount of fees paid to insurance company | USD $9,720 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $706,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,651 | | Amount paid for insurance broker fees | 9720 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE CORNERSTONE GROUP |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05996863 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05996863 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $5,928 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $63,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,928 | | Insurance broker name | GARLOW INSURANCE AGENCY |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | PREMIUM SAVER |
| Policy instance | 2 |
| Insurance contract or identification number | PREMIUM SAVER | | Number of Individuals Covered | 99 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $9,441 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICAL SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $62,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,294 | | Insurance broker name | MWL |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00447538 |
| Policy instance | 3 |
| Insurance contract or identification number | 00447538 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $7,504 | | Total amount of fees paid to insurance company | USD $5,035 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | F47-900 |
| Policy instance | 2 |
| Insurance contract or identification number | F47-900 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $12,046 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICAL SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $80,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 8044520000 |
| Policy instance | 1 |
| Insurance contract or identification number | 8044520000 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $19,636 | | Total amount of fees paid to insurance company | USD $10,220 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $785,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| STANDARD LIFE AND ACCIDENT INSURANCE (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | F47-900 |
| Policy instance | 2 |
| Insurance contract or identification number | F47-900 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $13,581 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICAL SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $107,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 108739 |
| Policy instance | 1 |
| Insurance contract or identification number | 108739 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $34,305 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $881,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00447538 |
| Policy instance | 3 |
| Insurance contract or identification number | 00447538 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $7,278 | | Total amount of fees paid to insurance company | USD $346 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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