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GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 401k Plan overview

Plan NameGROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.
Plan identification number 501

GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Supplemental unemployment
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

LITTLESTOWN FOUNDRY, INC. has sponsored the creation of one or more 401k plans.

Company Name:LITTLESTOWN FOUNDRY, INC.
Employer identification number (EIN):230814690
NAIC Classification:331500

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-09-01BOBBIE CASHMAN2024-01-03
5012021-09-01GLEN MORRELL2022-11-02
5012020-09-01GLEN MORRELL2021-12-30
5012019-09-01GLEN MORRELL2020-12-21
5012018-09-01GLEN MORRELL2020-01-06
5012017-09-01
5012016-09-01
5012015-09-01
5012014-09-01
5012013-09-01
5012012-09-01GLEN MORRELL
5012011-09-01GLEN MORRELL
5012010-09-01GLEN MORRELL
5012009-09-01GLEN MORRELL

Plan Statistics for GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.

401k plan membership statisitcs for GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.

Measure Date Value
2022: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2022 401k membership
Total participants, beginning-of-year2022-09-0161
Total number of active participants reported on line 7a of the Form 55002022-09-0159
Number of retired or separated participants receiving benefits2022-09-011
Number of other retired or separated participants entitled to future benefits2022-09-010
Total of all active and inactive participants2022-09-0160
2021: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2021 401k membership
Total participants, beginning-of-year2021-09-0160
Total number of active participants reported on line 7a of the Form 55002021-09-0160
Number of retired or separated participants receiving benefits2021-09-011
Total of all active and inactive participants2021-09-0161
2020: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2020 401k membership
Total participants, beginning-of-year2020-09-0165
Total number of active participants reported on line 7a of the Form 55002020-09-0159
Number of retired or separated participants receiving benefits2020-09-011
Total of all active and inactive participants2020-09-0160
2019: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2019 401k membership
Total participants, beginning-of-year2019-09-0171
Total number of active participants reported on line 7a of the Form 55002019-09-0163
Number of retired or separated participants receiving benefits2019-09-012
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-0165
2018: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2018 401k membership
Total participants, beginning-of-year2018-09-0169
Total number of active participants reported on line 7a of the Form 55002018-09-0171
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-0171
2017: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2017 401k membership
Total participants, beginning-of-year2017-09-0161
Total number of active participants reported on line 7a of the Form 55002017-09-0169
Number of retired or separated participants receiving benefits2017-09-010
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-0169
2016: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2016 401k membership
Total participants, beginning-of-year2016-09-0169
Total number of active participants reported on line 7a of the Form 55002016-09-0161
Number of retired or separated participants receiving benefits2016-09-010
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-0161
2015: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2015 401k membership
Total participants, beginning-of-year2015-09-0168
Total number of active participants reported on line 7a of the Form 55002015-09-0167
Number of retired or separated participants receiving benefits2015-09-011
Number of other retired or separated participants entitled to future benefits2015-09-011
Total of all active and inactive participants2015-09-0169
2014: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2014 401k membership
Total participants, beginning-of-year2014-09-0167
Total number of active participants reported on line 7a of the Form 55002014-09-0165
Number of retired or separated participants receiving benefits2014-09-013
Total of all active and inactive participants2014-09-0168
2013: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2013 401k membership
Total participants, beginning-of-year2013-09-0177
Total number of active participants reported on line 7a of the Form 55002013-09-0166
Number of retired or separated participants receiving benefits2013-09-011
Number of other retired or separated participants entitled to future benefits2013-09-010
Total of all active and inactive participants2013-09-0167
2012: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2012 401k membership
Total participants, beginning-of-year2012-09-0177
Total number of active participants reported on line 7a of the Form 55002012-09-0176
Number of retired or separated participants receiving benefits2012-09-011
Total of all active and inactive participants2012-09-0177
2011: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2011 401k membership
Total participants, beginning-of-year2011-09-0173
Total number of active participants reported on line 7a of the Form 55002011-09-0174
Number of retired or separated participants receiving benefits2011-09-013
Total of all active and inactive participants2011-09-0177
2010: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2010 401k membership
Total participants, beginning-of-year2010-09-0165
Total number of active participants reported on line 7a of the Form 55002010-09-0169
Number of retired or separated participants receiving benefits2010-09-014
Total of all active and inactive participants2010-09-0173
2009: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2009 401k membership
Total participants, beginning-of-year2009-09-0170
Total number of active participants reported on line 7a of the Form 55002009-09-0161
Number of retired or separated participants receiving benefits2009-09-014
Total of all active and inactive participants2009-09-0165

Financial Data on GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.

Measure Date Value
2023 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2023 401k financial data
Total plan liabilities at end of year2023-08-31$12,248
Total plan liabilities at beginning of year2023-08-31$8,494
Total income from all sources2023-08-31$1,079,838
Expenses. Total of all expenses incurred2023-08-31$888,751
Benefits paid (including direct rollovers)2023-08-31$888,751
Total plan assets at end of year2023-08-31$428,667
Total plan assets at beginning of year2023-08-31$233,826
Value of fidelity bond covering the plan2023-08-31$500,000
Total contributions received or receivable from participants2023-08-31$142,463
Other income received2023-08-31$7,838
Net income (gross income less expenses)2023-08-31$191,087
Net plan assets at end of year (total assets less liabilities)2023-08-31$416,419
Net plan assets at beginning of year (total assets less liabilities)2023-08-31$225,332
Total contributions received or receivable from employer(s)2023-08-31$929,537
2022 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2022 401k financial data
Total plan liabilities at end of year2022-08-31$8,494
Total plan liabilities at beginning of year2022-08-31$66,259
Total income from all sources2022-08-31$940,619
Expenses. Total of all expenses incurred2022-08-31$990,765
Benefits paid (including direct rollovers)2022-08-31$990,765
Total plan assets at end of year2022-08-31$233,826
Total plan assets at beginning of year2022-08-31$341,737
Value of fidelity bond covering the plan2022-08-31$500,000
Total contributions received or receivable from participants2022-08-31$152,723
Other income received2022-08-31$619
Net income (gross income less expenses)2022-08-31$-50,146
Net plan assets at end of year (total assets less liabilities)2022-08-31$225,332
Net plan assets at beginning of year (total assets less liabilities)2022-08-31$275,478
Total contributions received or receivable from employer(s)2022-08-31$787,277
2021 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2021 401k financial data
Total plan liabilities at end of year2021-08-31$66,259
Total plan liabilities at beginning of year2021-08-31$60,647
Total income from all sources2021-08-31$1,002,262
Expenses. Total of all expenses incurred2021-08-31$1,021,796
Benefits paid (including direct rollovers)2021-08-31$1,021,796
Total plan assets at end of year2021-08-31$341,737
Total plan assets at beginning of year2021-08-31$355,659
Value of fidelity bond covering the plan2021-08-31$500,000
Total contributions received or receivable from participants2021-08-31$137,949
Other income received2021-08-31$262
Net income (gross income less expenses)2021-08-31$-19,534
Net plan assets at end of year (total assets less liabilities)2021-08-31$275,478
Net plan assets at beginning of year (total assets less liabilities)2021-08-31$295,012
Total contributions received or receivable from employer(s)2021-08-31$864,051
2020 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2020 401k financial data
Total plan liabilities at end of year2020-08-31$60,647
Total plan liabilities at beginning of year2020-08-31$636,444
Total income from all sources2020-08-31$976,461
Expenses. Total of all expenses incurred2020-08-31$645,734
Benefits paid (including direct rollovers)2020-08-31$645,734
Total plan assets at end of year2020-08-31$355,659
Total plan assets at beginning of year2020-08-31$600,729
Value of fidelity bond covering the plan2020-08-31$500,000
Total contributions received or receivable from participants2020-08-31$134,235
Other income received2020-08-31$1,461
Net income (gross income less expenses)2020-08-31$330,727
Net plan assets at end of year (total assets less liabilities)2020-08-31$295,012
Net plan assets at beginning of year (total assets less liabilities)2020-08-31$-35,715
Total contributions received or receivable from employer(s)2020-08-31$840,765
2019 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2019 401k financial data
Total plan liabilities at end of year2019-08-31$636,444
Total plan liabilities at beginning of year2019-08-31$0
Total income from all sources2019-08-31$1,025,983
Expenses. Total of all expenses incurred2019-08-31$1,361,724
Benefits paid (including direct rollovers)2019-08-31$1,361,724
Total plan assets at end of year2019-08-31$600,729
Total plan assets at beginning of year2019-08-31$300,026
Value of fidelity bond covering the plan2019-08-31$500,000
Total contributions received or receivable from participants2019-08-31$134,987
Other income received2019-08-31$2,983
Net income (gross income less expenses)2019-08-31$-335,741
Net plan assets at end of year (total assets less liabilities)2019-08-31$-35,715
Net plan assets at beginning of year (total assets less liabilities)2019-08-31$300,026
Total contributions received or receivable from employer(s)2019-08-31$888,013
2018 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2018 401k financial data
Total income from all sources2018-08-31$841,387
Expenses. Total of all expenses incurred2018-08-31$715,256
Benefits paid (including direct rollovers)2018-08-31$664,214
Total plan assets at end of year2018-08-31$300,026
Total plan assets at beginning of year2018-08-31$173,895
Value of fidelity bond covering the plan2018-08-31$500,000
Total contributions received or receivable from participants2018-08-31$127,430
Expenses. Other expenses not covered elsewhere2018-08-31$51,042
Other income received2018-08-31$1,387
Net income (gross income less expenses)2018-08-31$126,131
Net plan assets at end of year (total assets less liabilities)2018-08-31$300,026
Net plan assets at beginning of year (total assets less liabilities)2018-08-31$173,895
Total contributions received or receivable from employer(s)2018-08-31$712,570
2017 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2017 401k financial data
Total income from all sources2017-08-31$725,291
Expenses. Total of all expenses incurred2017-08-31$694,775
Benefits paid (including direct rollovers)2017-08-31$694,775
Total plan assets at end of year2017-08-31$173,895
Total plan assets at beginning of year2017-08-31$143,379
Value of fidelity bond covering the plan2017-08-31$500,000
Total contributions received or receivable from participants2017-08-31$125,184
Other income received2017-08-31$291
Net income (gross income less expenses)2017-08-31$30,516
Net plan assets at end of year (total assets less liabilities)2017-08-31$173,895
Net plan assets at beginning of year (total assets less liabilities)2017-08-31$143,379
Total contributions received or receivable from employer(s)2017-08-31$599,816
2016 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2016 401k financial data
Total income from all sources2016-08-31$627,013
Expenses. Total of all expenses incurred2016-08-31$693,659
Benefits paid (including direct rollovers)2016-08-31$693,659
Total plan assets at end of year2016-08-31$143,379
Total plan assets at beginning of year2016-08-31$210,025
Value of fidelity bond covering the plan2016-08-31$500,000
Total contributions received or receivable from participants2016-08-31$131,596
Other income received2016-08-31$13
Net income (gross income less expenses)2016-08-31$-66,646
Net plan assets at end of year (total assets less liabilities)2016-08-31$143,379
Net plan assets at beginning of year (total assets less liabilities)2016-08-31$210,025
Total contributions received or receivable from employer(s)2016-08-31$495,404
2015 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2015 401k financial data
Total income from all sources2015-08-31$660,516
Expenses. Total of all expenses incurred2015-08-31$690,676
Benefits paid (including direct rollovers)2015-08-31$690,676
Total plan assets at end of year2015-08-31$210,025
Total plan assets at beginning of year2015-08-31$240,185
Value of fidelity bond covering the plan2015-08-31$500,000
Total contributions received or receivable from participants2015-08-31$133,403
Other income received2015-08-31$16
Net income (gross income less expenses)2015-08-31$-30,160
Net plan assets at end of year (total assets less liabilities)2015-08-31$210,025
Net plan assets at beginning of year (total assets less liabilities)2015-08-31$240,185
Total contributions received or receivable from employer(s)2015-08-31$527,097
2014 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2014 401k financial data
Total income from all sources2014-08-31$658,319
Expenses. Total of all expenses incurred2014-08-31$669,492
Benefits paid (including direct rollovers)2014-08-31$669,492
Total plan assets at end of year2014-08-31$240,185
Total plan assets at beginning of year2014-08-31$251,358
Value of fidelity bond covering the plan2014-08-31$500,000
Total contributions received or receivable from participants2014-08-31$128,268
Other income received2014-08-31$19
Net income (gross income less expenses)2014-08-31$-11,173
Net plan assets at end of year (total assets less liabilities)2014-08-31$240,185
Net plan assets at beginning of year (total assets less liabilities)2014-08-31$251,358
Total contributions received or receivable from employer(s)2014-08-31$530,032
2013 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2013 401k financial data
Total income from all sources2013-08-31$738,023
Expenses. Total of all expenses incurred2013-08-31$739,322
Benefits paid (including direct rollovers)2013-08-31$739,322
Total plan assets at end of year2013-08-31$251,358
Total plan assets at beginning of year2013-08-31$252,657
Value of fidelity bond covering the plan2013-08-31$500,000
Total contributions received or receivable from participants2013-08-31$118,952
Other income received2013-08-31$23
Net income (gross income less expenses)2013-08-31$-1,299
Net plan assets at end of year (total assets less liabilities)2013-08-31$251,358
Net plan assets at beginning of year (total assets less liabilities)2013-08-31$252,657
Total contributions received or receivable from employer(s)2013-08-31$619,048
2012 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2012 401k financial data
Total income from all sources2012-08-31$700,020
Expenses. Total of all expenses incurred2012-08-31$683,903
Benefits paid (including direct rollovers)2012-08-31$683,903
Total plan assets at end of year2012-08-31$252,657
Total plan assets at beginning of year2012-08-31$236,540
Value of fidelity bond covering the plan2012-08-31$500,000
Total contributions received or receivable from participants2012-08-31$110,669
Other income received2012-08-31$20
Net income (gross income less expenses)2012-08-31$16,117
Net plan assets at end of year (total assets less liabilities)2012-08-31$252,657
Net plan assets at beginning of year (total assets less liabilities)2012-08-31$236,540
Total contributions received or receivable from employer(s)2012-08-31$589,331
2011 : GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2011 401k financial data
Total plan liabilities at beginning of year2011-08-31$10,583
Total income from all sources2011-08-31$794,428
Expenses. Total of all expenses incurred2011-08-31$657,515
Benefits paid (including direct rollovers)2011-08-31$657,515
Total plan assets at end of year2011-08-31$236,540
Total plan assets at beginning of year2011-08-31$110,210
Value of fidelity bond covering the plan2011-08-31$500,000
Total contributions received or receivable from participants2011-08-31$104,409
Other income received2011-08-31$18
Net income (gross income less expenses)2011-08-31$136,913
Net plan assets at end of year (total assets less liabilities)2011-08-31$236,540
Net plan assets at beginning of year (total assets less liabilities)2011-08-31$99,627
Total contributions received or receivable from employer(s)2011-08-31$690,001

Form 5500 Responses for GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC.

2022: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan funding arrangement – TrustYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement - TrustYes
2021: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan funding arrangement – TrustYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement - TrustYes
2020: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – TrustYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement - TrustYes
2019: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – TrustYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement - TrustYes
2018: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – TrustYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement - TrustYes
2017: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – TrustYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement - TrustYes
2016: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – TrustYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement - TrustYes
2015: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan funding arrangement – TrustYes
2015-09-01Plan benefit arrangement – InsuranceYes
2015-09-01Plan benefit arrangement - TrustYes
2014: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan funding arrangement – TrustYes
2014-09-01Plan benefit arrangement – InsuranceYes
2014-09-01Plan benefit arrangement - TrustYes
2013: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan funding arrangement – TrustYes
2013-09-01Plan benefit arrangement – InsuranceYes
2013-09-01Plan benefit arrangement - TrustYes
2012: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan funding arrangement – TrustYes
2012-09-01Plan benefit arrangement – InsuranceYes
2012-09-01Plan benefit arrangement - TrustYes
2011: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan funding arrangement – TrustYes
2011-09-01Plan benefit arrangement – InsuranceYes
2011-09-01Plan benefit arrangement - TrustYes
2010: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan funding arrangement – TrustYes
2010-09-01Plan benefit arrangement – InsuranceYes
2010-09-01Plan benefit arrangement - TrustYes
2009: GROUP INSURANCE PLAN OF LITTLESTOWN FOUNDRY, INC. 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01This submission is the final filingNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan funding arrangement – TrustYes
2009-09-01Plan benefit arrangement – InsuranceYes
2009-09-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918433
Policy instance 3
Insurance contract or identification number918433
Number of Individuals Covered57
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,058
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,058
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 2
Insurance contract or identification numberF014444
Number of Individuals Covered69
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $6,968
Total amount of fees paid to insurance companyUSD $2,323
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $46,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,968
Insurance broker organization code?3
Amount paid for insurance broker fees2323
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered82
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918433
Policy instance 3
Insurance contract or identification number918433
Number of Individuals Covered55
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,180
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,180
Insurance broker organization code?3
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered92
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 2
Insurance contract or identification numberF014444
Number of Individuals Covered69
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $7,836
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,877
Insurance broker organization code?3
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered90
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 2
Insurance contract or identification numberF014444
Number of Individuals Covered64
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $8,236
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,177
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918433
Policy instance 3
Insurance contract or identification number918433
Number of Individuals Covered108
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $3,060
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,060
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918433
Policy instance 3
Insurance contract or identification number918433
Number of Individuals Covered112
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,055
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,055
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 2
Insurance contract or identification numberF014444
Number of Individuals Covered68
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $9,644
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $44,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,709
Insurance broker organization code?3
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered62
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 3
Insurance contract or identification numberF014444
Number of Individuals Covered83
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $6,934
Total amount of fees paid to insurance companyUSD $2,312
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $46,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,934
Insurance broker organization code?3
Amount paid for insurance broker fees2312
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered72
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000ZW413 & 00ZW
Policy instance 2
Insurance contract or identification number000ZW413 & 00ZW
Number of Individuals Covered61
Insurance policy start date2018-09-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $139
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $138
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918433
Policy instance 4
Insurance contract or identification number918433
Number of Individuals Covered68
Insurance policy start date2018-10-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,188
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,188
Insurance broker organization code?3
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 1
Insurance contract or identification number00529803
Number of Individuals Covered69
Insurance policy start date2017-09-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,732
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $221,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000ZW413 & 00ZW
Policy instance 2
Insurance contract or identification number000ZW413 & 00ZW
Number of Individuals Covered62
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $2,140
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 3
Insurance contract or identification numberF014444
Number of Individuals Covered75
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $6,120
Total amount of fees paid to insurance companyUSD $2,040
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00529803
Policy instance 4
Insurance contract or identification number00529803
Number of Individuals Covered68
Insurance policy start date2018-01-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014444
Policy instance 5
Insurance contract or identification numberF014444
Number of Individuals Covered70
Insurance policy start date2015-10-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $4,948
Total amount of fees paid to insurance companyUSD $1,649
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $33,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,948
Insurance broker organization code?3
Amount paid for insurance broker fees1649
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameCONSOLIDATED BENEFITS INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number225659
Policy instance 4
Insurance contract or identification number225659
Number of Individuals Covered107
Insurance policy start date2016-01-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $18,414
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $495,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,414
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL GROUP INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000ZW413 & 00ZW
Policy instance 3
Insurance contract or identification number000ZW413 & 00ZW
Number of Individuals Covered52
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $2,078
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,057
Insurance broker organization code?3
Insurance broker nameINDEPENDENCE PLANNING GROUP, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155297
Policy instance 2
Insurance contract or identification number155297
Number of Individuals Covered66
Insurance policy start date2015-09-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $267
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $267
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL GROUP, INC.
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered107
Insurance policy start date2015-09-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,779
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $214,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,779
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000ZW413 & 00ZW
Policy instance 3
Insurance contract or identification number000ZW413 & 00ZW
Number of Individuals Covered48
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $1,884
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,865
Insurance broker organization code?3
Insurance broker nameINDEPENDENCE PLANNING GROUP, LLC
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered61
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $19,222
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $653,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,222
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155297
Policy instance 2
Insurance contract or identification number155297
Number of Individuals Covered68
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $4,436
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,436
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL GROUP, INC.
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered66
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $13,530
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $418,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,530
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number072154
Policy instance 2
Insurance contract or identification number072154
Number of Individuals Covered0
Insurance policy start date2013-09-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,792
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $218,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,792
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00480518
Policy instance 3
Insurance contract or identification number00480518
Number of Individuals Covered55
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $1,925
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,903
Insurance broker organization code?3
Insurance broker nameINDEPENDENCE PLANNING GROUP, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155297
Policy instance 4
Insurance contract or identification number155297
Number of Individuals Covered72
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $4,794
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,794
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL GROUP, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129368
Policy instance 2
Insurance contract or identification number129368
Number of Individuals Covered74
Insurance policy start date2012-09-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $448
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $448
Insurance broker organization code?3
Insurance broker nameALPHA BENEFITS GROUP, INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number072154
Policy instance 3
Insurance contract or identification number072154
Number of Individuals Covered71
Insurance policy start date2013-01-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $20,916
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,916
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00480518
Policy instance 4
Insurance contract or identification number00480518
Number of Individuals Covered57
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $1,798
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,732
Insurance broker organization code?3
Insurance broker nameINDEPENDENCE PLANNING GROUP, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155297
Policy instance 5
Insurance contract or identification number155297
Number of Individuals Covered75
Insurance policy start date2012-10-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $5,531
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,531
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered72
Insurance policy start date2012-09-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,417
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $217,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,417
Insurance broker organization code?3
Insurance broker nameCOMMONWEALTH FINANCIAL, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129368
Policy instance 2
Insurance contract or identification number129368
Number of Individuals Covered74
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $4,944
Total amount of fees paid to insurance companyUSD $313
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered73
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $13,632
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $397,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129369
Policy instance 3
Insurance contract or identification number129369
Number of Individuals Covered7
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $398
Total amount of fees paid to insurance companyUSD $20
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number072154
Policy instance 4
Insurance contract or identification number072154
Number of Individuals Covered0
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $10,332
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $246,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129368
Policy instance 2
Insurance contract or identification number129368
Number of Individuals Covered74
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $4,708
Total amount of fees paid to insurance companyUSD $296
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129369
Policy instance 3
Insurance contract or identification number129369
Number of Individuals Covered10
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $426
Total amount of fees paid to insurance companyUSD $21
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number072154
Policy instance 4
Insurance contract or identification number072154
Number of Individuals Covered72
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $20,376
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $478,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00518877
Policy instance 1
Insurance contract or identification number00518877
Number of Individuals Covered0
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $9,009
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $200,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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