ROOFING SUPPLY GROUP, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN
401k plan membership statisitcs for ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN
| Measure | Date | Value |
|---|
| 2013 : ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $395,188 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-08-31 | $361,501 |
| Total income from all sources (including contributions) | 2013-08-31 | $7,107,106 |
| Total of all expenses incurred | 2013-08-31 | $7,464,145 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-08-31 | $6,340,557 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-08-31 | $7,026,443 |
| Value of total assets at end of year | 2013-08-31 | $394,524 |
| Value of total assets at beginning of year | 2013-08-31 | $717,876 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-08-31 | $1,123,588 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-08-31 | No |
| Administrative expenses professional fees incurred | 2013-08-31 | $15,500 |
| Was this plan covered by a fidelity bond | 2013-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-08-31 | No |
| Contributions received from participants | 2013-08-31 | $3,346,837 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-08-31 | $86,172 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-08-31 | $27,470 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-08-31 | $142,028 |
| Other income not declared elsewhere | 2013-08-31 | $80,663 |
| Administrative expenses (other) incurred | 2013-08-31 | $581,744 |
| Liabilities. Value of operating payables at end of year | 2013-08-31 | $15,500 |
| Liabilities. Value of operating payables at beginning of year | 2013-08-31 | $14,000 |
| Total non interest bearing cash at beginning of year | 2013-08-31 | $245,467 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-08-31 | No |
| Value of net income/loss | 2013-08-31 | $-357,039 |
| Value of net assets at end of year (total assets less liabilities) | 2013-08-31 | $-664 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-08-31 | $356,375 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-08-31 | No |
| Value of interest in common/collective trusts at end of year | 2013-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-08-31 | $6,340,557 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-08-31 | No |
| Contributions received in cash from employer | 2013-08-31 | $3,593,434 |
| Employer contributions (assets) at end of year | 2013-08-31 | $367,054 |
| Employer contributions (assets) at beginning of year | 2013-08-31 | $330,381 |
| Contract administrator fees | 2013-08-31 | $526,344 |
| Liabilities. Value of benefit claims payable at end of year | 2013-08-31 | $379,688 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-08-31 | $347,501 |
| Did the plan have assets held for investment | 2013-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-08-31 | Unqualified |
| Accountancy firm name | 2013-08-31 | PJ WILSON COMPANY, LLC |
| Accountancy firm EIN | 2013-08-31 | 272691867 |
| 2012 : ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $361,501 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $665,669 |
| Total income from all sources (including contributions) | 2012-08-31 | $7,200,749 |
| Total of all expenses incurred | 2012-08-31 | $6,837,041 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-08-31 | $5,761,041 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-08-31 | $6,823,050 |
| Value of total assets at end of year | 2012-08-31 | $717,876 |
| Value of total assets at beginning of year | 2012-08-31 | $658,336 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-08-31 | $1,076,000 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-08-31 | No |
| Administrative expenses professional fees incurred | 2012-08-31 | $14,000 |
| Was this plan covered by a fidelity bond | 2012-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-08-31 | No |
| Contributions received from participants | 2012-08-31 | $2,998,647 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-08-31 | $77,513 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-08-31 | $142,028 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-08-31 | $5,716 |
| Other income not declared elsewhere | 2012-08-31 | $377,699 |
| Administrative expenses (other) incurred | 2012-08-31 | $462,128 |
| Liabilities. Value of operating payables at end of year | 2012-08-31 | $14,000 |
| Liabilities. Value of operating payables at beginning of year | 2012-08-31 | $13,500 |
| Total non interest bearing cash at end of year | 2012-08-31 | $245,467 |
| Total non interest bearing cash at beginning of year | 2012-08-31 | $23,579 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Value of net income/loss | 2012-08-31 | $363,708 |
| Value of net assets at end of year (total assets less liabilities) | 2012-08-31 | $356,375 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-08-31 | $-7,333 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-08-31 | No |
| Investment advisory and management fees | 2012-08-31 | $599,872 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-08-31 | No |
| Contributions received in cash from employer | 2012-08-31 | $3,746,890 |
| Employer contributions (assets) at end of year | 2012-08-31 | $330,381 |
| Employer contributions (assets) at beginning of year | 2012-08-31 | $629,041 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-08-31 | $5,761,041 |
| Liabilities. Value of benefit claims payable at end of year | 2012-08-31 | $347,501 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-08-31 | $652,169 |
| Did the plan have assets held for investment | 2012-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-08-31 | Unqualified |
| Accountancy firm name | 2012-08-31 | PJ WILSON COMPANY, LLC |
| Accountancy firm EIN | 2012-08-31 | 272691867 |
| 2011 : ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $665,669 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $503,237 |
| Total income from all sources (including contributions) | 2011-08-31 | $5,629,499 |
| Total of all expenses incurred | 2011-08-31 | $5,651,457 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-08-31 | $4,754,848 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-08-31 | $5,599,727 |
| Value of total assets at end of year | 2011-08-31 | $658,336 |
| Value of total assets at beginning of year | 2011-08-31 | $517,862 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-08-31 | $896,609 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-08-31 | No |
| Administrative expenses professional fees incurred | 2011-08-31 | $13,500 |
| Was this plan covered by a fidelity bond | 2011-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-08-31 | No |
| Contributions received from participants | 2011-08-31 | $2,723,918 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-08-31 | $86,674 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-08-31 | $5,716 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-08-31 | $125,368 |
| Other income not declared elsewhere | 2011-08-31 | $29,772 |
| Liabilities. Value of operating payables at end of year | 2011-08-31 | $13,500 |
| Liabilities. Value of operating payables at beginning of year | 2011-08-31 | $13,000 |
| Total non interest bearing cash at end of year | 2011-08-31 | $23,579 |
| Total non interest bearing cash at beginning of year | 2011-08-31 | $5,851 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-08-31 | No |
| Value of net income/loss | 2011-08-31 | $-21,958 |
| Value of net assets at end of year (total assets less liabilities) | 2011-08-31 | $-7,333 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-08-31 | $14,625 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-08-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-08-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-08-31 | No |
| Contributions received in cash from employer | 2011-08-31 | $2,789,135 |
| Employer contributions (assets) at end of year | 2011-08-31 | $629,041 |
| Employer contributions (assets) at beginning of year | 2011-08-31 | $386,643 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-08-31 | $4,754,848 |
| Contract administrator fees | 2011-08-31 | $883,109 |
| Liabilities. Value of benefit claims payable at end of year | 2011-08-31 | $652,169 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-08-31 | $490,237 |
| Did the plan have assets held for investment | 2011-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-08-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-08-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-08-31 | Unqualified |
| Accountancy firm name | 2011-08-31 | PJ WILSON COMPANY, LLC |
| Accountancy firm EIN | 2011-08-31 | 272691867 |
| 2015: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | Yes |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 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: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – Trust | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement - Trust | Yes |
| 2011: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – Trust | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement - Trust | Yes |
| 2009: ROOFING SUPPLY GROUP, LLC EMPLOYEE HEALTHCARE PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | Yes |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – Trust | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement - Trust | Yes |
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan funding arrangement – Trust | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement - Trust | Yes |
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 680094 |
| Policy instance | 3 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,805 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT CRITICAL ILLNESS | | 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 Carrier | USD $97,783 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,487 | | Insurance broker organization code? | 3 | | Insurance broker name | DONNA M. BAKER |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 1 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 891 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $66,644 | | Total amount of fees paid to insurance company | USD $1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,188 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | NON-MONETARY | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F013625 |
| Policy instance | 2 |
| Insurance contract or identification number | F013625 | | Number of Individuals Covered | 1239 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $111,107 | | Total amount of fees paid to insurance company | USD $33,606 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $653,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,006 | | Amount paid for insurance broker fees | 32678 | | Additional information about fees paid to insurance broker | ADDITONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADVISORS SVCS., GROUP, LLC |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 ) |
| Policy contract number | 680094 |
| Policy instance | 4 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 744 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $12,230 | | Total amount of fees paid to insurance company | USD $1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $113,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,902 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 1 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 747 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $27,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 2 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 864 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $16,273 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $138,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,273 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES INC. |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F013625 |
| Policy instance | 3 |
| Insurance contract or identification number | F013625 | | Number of Individuals Covered | 1173 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $36,333 | | Total amount of fees paid to insurance company | USD $10,874 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $213,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,973 | | Amount paid for insurance broker fees | 10780 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADVISORS SERVICES GROUP LLC |
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| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 2 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 839 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $51,036 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,036 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES INC. |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F013625 |
| Policy instance | 3 |
| Insurance contract or identification number | F013625 | | Number of Individuals Covered | 1235 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $110,772 | | Total amount of fees paid to insurance company | USD $33,082 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $651,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97,479 | | Amount paid for insurance broker fees | 33022 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT ADVISORS SERVICES GROUP LLC |
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| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 ) |
| Policy contract number | 680094 |
| Policy instance | 1 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 743 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $15,220 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $626,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,220 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES INC. |
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| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 ) |
| Policy contract number | 680094 |
| Policy instance | 2 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 648 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $3,856 | | Total amount of fees paid to insurance company | USD $2,821 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,856 | | Amount paid for insurance broker fees | 2821 | | Additional information about fees paid to insurance broker | VOLUME INCEDNTIVES | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES HOUSTON |
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| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 3 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 772 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $46,854 | | Total amount of fees paid to insurance company | USD $9,522 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,854 | | Amount paid for insurance broker fees | 9522 | | Additional information about fees paid to insurance broker | VOLUME INCENTIVES | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 025388 |
| Policy instance | 4 |
| Insurance contract or identification number | 025388 | | Number of Individuals Covered | 1841 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $148,128 | | Total amount of fees paid to insurance company | USD $441,789 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $581,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $148,128 | | Amount paid for insurance broker fees | 9924 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BLUE CROSS BLUE SHIELD OF TEXAS |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F013625 |
| Policy instance | 1 |
| Insurance contract or identification number | F013625 | | Number of Individuals Covered | 1118 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $97,334 | | Total amount of fees paid to insurance company | USD $29,090 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,680 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES INC. |
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| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 5 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 730 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $63,364 | | Total amount of fees paid to insurance company | USD $10,747 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 069415 |
| Policy instance | 4 |
| Insurance contract or identification number | 069415 | | Number of Individuals Covered | 1024 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-09-01 | | Total amount of commissions paid to insurance broker | USD $37,718 | | Total amount of fees paid to insurance company | USD $6,630 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142187 |
| Policy instance | 3 |
| Insurance contract or identification number | 0142187 | | Number of Individuals Covered | 1438 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $50,895 | | Total amount of fees paid to insurance company | USD $5,863 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $316,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 ) |
| Policy contract number | 680094 |
| Policy instance | 2 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 586 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $7,181 | | Total amount of fees paid to insurance company | USD $5,607 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-011879-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-011879-000 | | Number of Individuals Covered | 845 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $473,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 025388 |
| Policy instance | 6 |
| Insurance contract or identification number | 025388 | | Number of Individuals Covered | 1732 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $145,482 | | Total amount of fees paid to insurance company | USD $432,056 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 4 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $26,275 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 069415 |
| Policy instance | 3 |
| Insurance contract or identification number | 069415 | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-09-01 | | Total amount of commissions paid to insurance broker | USD $33,811 | | Total amount of fees paid to insurance company | USD $3,857 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0142187 |
| Policy instance | 2 |
| Insurance contract or identification number | 0142187 | | Number of Individuals Covered | 1414 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $41,363 | | Total amount of fees paid to insurance company | USD $5,515 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $284,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
| Policy contract number | 680094 |
| Policy instance | 1 |
| Insurance contract or identification number | 680094 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $8,126 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 025388 |
| Policy instance | 5 |
| Insurance contract or identification number | 025388 | | Number of Individuals Covered | 1702 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $139,357 | | Total amount of fees paid to insurance company | USD $365,438 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $377,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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