JEWISH FEDERATION OF SOUTHERN NEW JERSEY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT
401k plan membership statisitcs for JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT
| Measure | Date | Value |
|---|
| 2022: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 287 |
| Total of all active and inactive participants | 2022-04-01 | 287 |
| 2021: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 240 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 223 |
| Total of all active and inactive participants | 2021-04-01 | 223 |
| 2020: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 269 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 240 |
| Total of all active and inactive participants | 2020-04-01 | 240 |
| 2019: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 269 |
| Total of all active and inactive participants | 2019-04-01 | 269 |
| 2018: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 227 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 97 |
| Total of all active and inactive participants | 2018-04-01 | 97 |
| 2017: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 227 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 101 |
| Total of all active and inactive participants | 2017-04-01 | 101 |
| 2016: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 216 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 227 |
| Total of all active and inactive participants | 2016-04-01 | 227 |
| 2015: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 216 |
| Total of all active and inactive participants | 2015-04-01 | 216 |
| 2014: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 205 |
| Total of all active and inactive participants | 2014-04-01 | 205 |
| 2013: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 97 |
| Total of all active and inactive participants | 2013-04-01 | 97 |
| 2012: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 218 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 207 |
| Total of all active and inactive participants | 2012-04-01 | 207 |
| 2011: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 218 |
| Total of all active and inactive participants | 2011-04-01 | 218 |
| 2010: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-04-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 168 |
| Total of all active and inactive participants | 2010-04-01 | 168 |
| 2009: JEWISH FEDERATION OF SOUTHERN NEW JERSEY HMO CONTRACT 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 187 |
| Total of all active and inactive participants | 2009-04-01 | 187 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30029521 |
| Policy instance | 6 |
| Insurance contract or identification number | 30029521 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $748 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $534 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0011497111 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011497111 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-04-01 | | Total amount of commissions paid to insurance broker | USD $1,703 | | Total amount of fees paid to insurance company | USD $122 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,021 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $491 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0688036 |
| Policy instance | 4 |
| Insurance contract or identification number | R0688036 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-04-01 | | Total amount of commissions paid to insurance broker | USD $777 | | Total amount of fees paid to insurance company | USD $84 | | Other welfare benefits provided | GRPACCVO | | Welfare Benefit Premiums Paid to Carrier | USD $3,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $233 | | Amount paid for insurance broker fees | 35 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0148934 |
| Policy instance | 3 |
| Insurance contract or identification number | 0148934 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $20,978 | | 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 $1,388,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,025 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-04-01 | | Total amount of commissions paid to insurance broker | USD $2,356 | | Total amount of fees paid to insurance company | USD $319 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,156 | | Amount paid for insurance broker fees | 154 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-04-01 | | Total amount of commissions paid to insurance broker | USD $9,576 | | Total amount of fees paid to insurance company | USD $2,051 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $70,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,709 | | Amount paid for insurance broker fees | 990 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-04-01 | | Total amount of commissions paid to insurance broker | USD $4,939 | | Total amount of fees paid to insurance company | USD $1,664 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $57,388 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,457 | | Amount paid for insurance broker fees | 803 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-04-01 | | Total amount of commissions paid to insurance broker | USD $1,504 | | Total amount of fees paid to insurance company | USD $290 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,053 | | Amount paid for insurance broker fees | 140 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0148934 |
| Policy instance | 3 |
| Insurance contract or identification number | 0148934 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $19,904 | | 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 $1,282,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,031 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0688036 |
| Policy instance | 4 |
| Insurance contract or identification number | R0688036 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-04-01 | | Total amount of commissions paid to insurance broker | USD $1,863 | | Total amount of fees paid to insurance company | USD $228 | | Other welfare benefits provided | GRPACCVO | | Welfare Benefit Premiums Paid to Carrier | USD $4,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $556 | | Amount paid for insurance broker fees | 96 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0011497111 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011497111 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-04-01 | | Total amount of commissions paid to insurance broker | USD $4,233 | | Total amount of fees paid to insurance company | USD $343 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,239 | | Amount paid for insurance broker fees | 144 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30029521 |
| Policy instance | 6 |
| Insurance contract or identification number | 30029521 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $729 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $551 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-04-01 | | Total amount of commissions paid to insurance broker | USD $5,059 | | Total amount of fees paid to insurance company | USD $2,233 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $58,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,058 | | Amount paid for insurance broker fees | 544 | | Additional information about fees paid to insurance broker | ADDDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-04-01 | | Total amount of commissions paid to insurance broker | USD $1,651 | | Total amount of fees paid to insurance company | USD $418 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $761 | | Amount paid for insurance broker fees | 101 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0148934 |
| Policy instance | 3 |
| Insurance contract or identification number | 0148934 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,569 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,209,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,569 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0688036 |
| Policy instance | 4 |
| Insurance contract or identification number | R0688036 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-04-01 | | Total amount of commissions paid to insurance broker | USD $51 | | Total amount of fees paid to insurance company | USD $1 | | Other welfare benefits provided | GRPACCVO | | Welfare Benefit Premiums Paid to Carrier | USD $1,700 | | 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 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0011497111 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011497111 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-04-01 | | Total amount of commissions paid to insurance broker | USD $69 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $5,544 | | Total amount of fees paid to insurance company | USD $3,956 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,881 | | Amount paid for insurance broker fees | 549 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $1,663 | | Total amount of fees paid to insurance company | USD $645 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,164 | | Amount paid for insurance broker fees | 90 | | Additional information about fees paid to insurance broker | ADDITIONAL 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 | 00625096 |
| Policy instance | 3 |
| Insurance contract or identification number | 00625096 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $71,946 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,080,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 44812 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR FEES | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-04-01 | | Total amount of commissions paid to insurance broker | USD $4,014 | | Total amount of fees paid to insurance company | USD $2,910 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,531 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,810 | | Amount paid for insurance broker fees | 433 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-04-01 | | Total amount of commissions paid to insurance broker | USD $1,660 | | Total amount of fees paid to insurance company | USD $651 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,162 | | Amount paid for insurance broker fees | 97 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 301565 |
| Policy instance | 3 |
| Insurance contract or identification number | VPL 301565 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $961 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LTD | | Welfare Benefit Premiums Paid to Carrier | USD $4,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $721 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 0003 |
| Policy instance | 4 |
| Insurance contract or identification number | 098433 0003 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-04-01 | | Total amount of commissions paid to insurance broker | USD $5 | | Total amount of fees paid to insurance company | USD $3 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35 | | 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 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0011497111 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011497111 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $2,178 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,307 | | Insurance broker name | MCCELLAN, DAVID, JOEL |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0688036 |
| Policy instance | 4 |
| Insurance contract or identification number | R0688036 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $1,247 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GRPACCVO | | Welfare Benefit Premiums Paid to Carrier | USD $1,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $748 | | Insurance broker name | MCCELLAN, DAVID, JOEL |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 301565 |
| Policy instance | 3 |
| Insurance contract or identification number | VPL 301565 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $967 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Commission paid to Insurance Broker | USD $725 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098433 |
| Policy instance | 2 |
| Insurance contract or identification number | 098433 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $1,366 | | Total amount of fees paid to insurance company | USD $536 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $956 | | Amount paid for insurance broker fees | 80 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $5,040 | | Total amount of fees paid to insurance company | USD $3,418 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,528 | | Amount paid for insurance broker fees | 509 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-04-01 | | Total amount of commissions paid to insurance broker | USD $3,693 | | Total amount of fees paid to insurance company | USD $2,338 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,693 | | Amount paid for insurance broker fees | 339 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301565 |
| Policy instance | 2 |
| Insurance contract or identification number | VPL301565 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $4,177 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,368 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID & CO |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 147854 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 147854 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $1,418 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,115 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID & CO |
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| NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 ) |
| Policy contract number | LA24 |
| Policy instance | 4 |
| Insurance contract or identification number | LA24 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $42,961 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $766,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,301 | | Insurance broker name | EMERSON REID & CO |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 2 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $28,117 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,117 | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 3 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,013 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,013 | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301565 |
| Policy instance | 4 |
| Insurance contract or identification number | VPL301565 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $467 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,111 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $467 | | Insurance broker organization code? | 3 | | Insurance broker name | LEON L. LEVY & ASSOCIATES |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-04-01 | | Total amount of commissions paid to insurance broker | USD $3,740 | | Total amount of fees paid to insurance company | USD $2,284 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,740 | | Amount paid for insurance broker fees | 298 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 098432 |
| Policy instance | 1 |
| Insurance contract or identification number | 098432 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Total amount of commissions paid to insurance broker | USD $3,682 | | Total amount of fees paid to insurance company | USD $2,272 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,682 | | Amount paid for insurance broker fees | 323 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 3 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,792 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,792 | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 2 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $28,319 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,319 | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 134662 |
| Policy instance | 2 |
| Insurance contract or identification number | 134662 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-05-01 | | Total amount of commissions paid to insurance broker | USD $3,419 | | Total amount of fees paid to insurance company | USD $128 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $15,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,419 | | Amount paid for insurance broker fees | 128 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LEON L LEVY & ASSOCIATES INC |
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| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 ) |
| Policy contract number | US427666 |
| Policy instance | 1 |
| Insurance contract or identification number | US427666 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,279 | | Total amount of fees paid to insurance company | USD $4,877 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $237,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,279 | | Amount paid for insurance broker fees | 4877 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 3 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,849 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,849 | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86387 |
| Policy instance | 4 |
| Insurance contract or identification number | 86387 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,280 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,280 | | Insurance broker organization code? | 3 | | Insurance broker name | KAMINER FINANCIAL GROUP, LTD |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 134662 |
| Policy instance | 2 |
| Insurance contract or identification number | 134662 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-05-01 | | Total amount of commissions paid to insurance broker | USD $3,001 | | Total amount of fees paid to insurance company | USD $112 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $16,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 ) |
| Policy contract number | US427666 |
| Policy instance | 1 |
| Insurance contract or identification number | US427666 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $26,271 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $951,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 867381G |
| Policy instance | 5 |
| Insurance contract or identification number | 867381G | | Number of Individuals Covered | 37 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $1,456 | | 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 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 113349 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 113349 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $1,224 | | Total amount of fees paid to insurance company | USD $179 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85895 |
| Policy instance | 1 |
| Insurance contract or identification number | 85895 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $12,029 | | 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 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $464,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85895 |
| Policy instance | 2 |
| Insurance contract or identification number | 85895 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $2,534 | | 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 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL140569 |
| Policy instance | 3 |
| Insurance contract or identification number | GL140569 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $2,090 | | Total amount of fees paid to insurance company | USD $611 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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