MID PENN BANK has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MID PENN BANK GROUP BENEFITS PLAN
Measure | Date | Value |
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2021: MID PENN BANK GROUP BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 383 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 492 |
Number of retired or separated participants receiving benefits | 2021-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
Total of all active and inactive participants | 2021-10-01 | 492 |
2020: MID PENN BANK GROUP BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 394 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 383 |
Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
Total of all active and inactive participants | 2020-10-01 | 383 |
2019: MID PENN BANK GROUP BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 333 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 394 |
Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
Total of all active and inactive participants | 2019-10-01 | 394 |
2018: MID PENN BANK GROUP BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 333 |
Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
Total of all active and inactive participants | 2018-10-01 | 333 |
2017: MID PENN BANK GROUP BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 227 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 312 |
Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
Total of all active and inactive participants | 2017-10-01 | 312 |
2016: MID PENN BANK GROUP BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 241 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 227 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
Total of all active and inactive participants | 2016-10-01 | 227 |
2015: MID PENN BANK GROUP BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 244 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 241 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
Total of all active and inactive participants | 2015-10-01 | 241 |
2014: MID PENN BANK GROUP BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 196 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 244 |
Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
Total of all active and inactive participants | 2014-10-01 | 244 |
2013: MID PENN BANK GROUP BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 199 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 196 |
Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
Total of all active and inactive participants | 2013-10-01 | 196 |
2012: MID PENN BANK GROUP BENEFITS PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 195 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 199 |
Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
Total of all active and inactive participants | 2012-10-01 | 199 |
2011: MID PENN BANK GROUP BENEFITS PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-10-01 | 185 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 174 |
Number of retired or separated participants receiving benefits | 2011-10-01 | 21 |
Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
Total of all active and inactive participants | 2011-10-01 | 195 |
2010: MID PENN BANK GROUP BENEFITS PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-10-01 | 181 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 165 |
Number of retired or separated participants receiving benefits | 2010-10-01 | 20 |
Total of all active and inactive participants | 2010-10-01 | 185 |
2009: MID PENN BANK GROUP BENEFITS PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-10-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 160 |
Number of retired or separated participants receiving benefits | 2009-10-01 | 21 |
Total of all active and inactive participants | 2009-10-01 | 181 |
2008: MID PENN BANK GROUP BENEFITS PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-10-01 | 164 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 164 |
Total of all active and inactive participants | 2008-10-01 | 164 |
2007: MID PENN BANK GROUP BENEFITS PLAN 2007 401k membership |
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Total participants, beginning-of-year | 2007-10-01 | 167 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-10-01 | 164 |
Total of all active and inactive participants | 2007-10-01 | 164 |
2006: MID PENN BANK GROUP BENEFITS PLAN 2006 401k membership |
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Total participants, beginning-of-year | 2006-10-01 | 167 |
Total number of active participants reported on line 7a of the Form 5500 | 2006-10-01 | 167 |
Total of all active and inactive participants | 2006-10-01 | 167 |
2005: MID PENN BANK GROUP BENEFITS PLAN 2005 401k membership |
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Total participants, beginning-of-year | 2005-10-01 | 109 |
Total number of active participants reported on line 7a of the Form 5500 | 2005-10-01 | 167 |
Total of all active and inactive participants | 2005-10-01 | 167 |
2021: MID PENN BANK GROUP BENEFITS PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Submission has been amended | No |
2021-10-01 | This submission is the final filing | No |
2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-10-01 | Plan is a collectively bargained plan | No |
2021-10-01 | Plan funding arrangement – Insurance | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2020: MID PENN BANK GROUP BENEFITS PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Submission has been amended | No |
2020-10-01 | This submission is the final filing | No |
2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-10-01 | Plan is a collectively bargained plan | No |
2020-10-01 | Plan funding arrangement – Insurance | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2019: MID PENN BANK GROUP BENEFITS PLAN 2019 form 5500 responses |
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2019-10-01 | Type of plan entity | Single employer plan |
2019-10-01 | Submission has been amended | No |
2019-10-01 | This submission is the final filing | No |
2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-10-01 | Plan is a collectively bargained plan | No |
2019-10-01 | Plan funding arrangement – Insurance | Yes |
2019-10-01 | Plan benefit arrangement – Insurance | Yes |
2018: MID PENN BANK GROUP BENEFITS PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Submission has been amended | No |
2018-10-01 | This submission is the final filing | No |
2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-10-01 | Plan is a collectively bargained plan | No |
2018-10-01 | Plan funding arrangement – Insurance | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: MID PENN BANK GROUP BENEFITS PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Submission has been amended | No |
2017-10-01 | This submission is the final filing | No |
2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-10-01 | Plan is a collectively bargained plan | No |
2017-10-01 | Plan funding arrangement – Insurance | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: MID PENN BANK GROUP BENEFITS PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2015: MID PENN BANK GROUP BENEFITS PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2014: MID PENN BANK GROUP BENEFITS PLAN 2014 form 5500 responses |
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2014-10-01 | Type of plan entity | Single employer plan |
2014-10-01 | Submission has been amended | No |
2014-10-01 | This submission is the final filing | No |
2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-10-01 | Plan is a collectively bargained plan | No |
2014-10-01 | Plan funding arrangement – Insurance | Yes |
2014-10-01 | Plan benefit arrangement – Insurance | Yes |
2013: MID PENN BANK GROUP BENEFITS PLAN 2013 form 5500 responses |
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2013-10-01 | Type of plan entity | Single employer plan |
2013-10-01 | Submission has been amended | No |
2013-10-01 | This submission is the final filing | No |
2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-10-01 | Plan is a collectively bargained plan | No |
2013-10-01 | Plan funding arrangement – Insurance | Yes |
2013-10-01 | Plan benefit arrangement – Insurance | Yes |
2012: MID PENN BANK GROUP BENEFITS PLAN 2012 form 5500 responses |
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2012-10-01 | Type of plan entity | Single employer plan |
2012-10-01 | Submission has been amended | No |
2012-10-01 | This submission is the final filing | No |
2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-10-01 | Plan is a collectively bargained plan | No |
2012-10-01 | Plan funding arrangement – Insurance | Yes |
2012-10-01 | Plan benefit arrangement – Insurance | Yes |
2011: MID PENN BANK GROUP BENEFITS PLAN 2011 form 5500 responses |
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2011-10-01 | Type of plan entity | Single employer plan |
2011-10-01 | Submission has been amended | No |
2011-10-01 | This submission is the final filing | No |
2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-10-01 | Plan is a collectively bargained plan | No |
2011-10-01 | Plan funding arrangement – Insurance | Yes |
2011-10-01 | Plan benefit arrangement – Insurance | Yes |
2010: MID PENN BANK GROUP BENEFITS PLAN 2010 form 5500 responses |
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2010-10-01 | Type of plan entity | Single employer plan |
2010-10-01 | Submission has been amended | No |
2010-10-01 | This submission is the final filing | No |
2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-10-01 | Plan is a collectively bargained plan | No |
2010-10-01 | Plan funding arrangement – Insurance | Yes |
2010-10-01 | Plan benefit arrangement – Insurance | Yes |
2009: MID PENN BANK GROUP BENEFITS PLAN 2009 form 5500 responses |
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2009-10-01 | Type of plan entity | Single employer plan |
2009-10-01 | Submission has been amended | No |
2009-10-01 | This submission is the final filing | No |
2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-10-01 | Plan is a collectively bargained plan | No |
2009-10-01 | Plan funding arrangement – Insurance | Yes |
2009-10-01 | Plan benefit arrangement – Insurance | Yes |
2008: MID PENN BANK GROUP BENEFITS PLAN 2008 form 5500 responses |
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2008-10-01 | Type of plan entity | Single employer plan |
2008-10-01 | Submission has been amended | No |
2008-10-01 | This submission is the final filing | No |
2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-10-01 | Plan is a collectively bargained plan | No |
2008-10-01 | Plan funding arrangement – Insurance | Yes |
2008-10-01 | Plan benefit arrangement – Insurance | Yes |
2007: MID PENN BANK GROUP BENEFITS PLAN 2007 form 5500 responses |
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2007-10-01 | Type of plan entity | Single employer plan |
2007-10-01 | Submission has been amended | No |
2007-10-01 | This submission is the final filing | No |
2007-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2007-10-01 | Plan is a collectively bargained plan | No |
2007-10-01 | Plan funding arrangement – Insurance | Yes |
2007-10-01 | Plan benefit arrangement – Insurance | Yes |
2006: MID PENN BANK GROUP BENEFITS PLAN 2006 form 5500 responses |
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2006-10-01 | Type of plan entity | Single employer plan |
2006-10-01 | Submission has been amended | No |
2006-10-01 | This submission is the final filing | No |
2006-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2006-10-01 | Plan is a collectively bargained plan | No |
2006-10-01 | Plan funding arrangement – Insurance | Yes |
2006-10-01 | Plan benefit arrangement – Insurance | Yes |
2005: MID PENN BANK GROUP BENEFITS PLAN 2005 form 5500 responses |
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2005-10-01 | Type of plan entity | Single employer plan |
2005-10-01 | First time form 5500 has been submitted | Yes |
2005-10-01 | Submission has been amended | No |
2005-10-01 | This submission is the final filing | No |
2005-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2005-10-01 | Plan is a collectively bargained plan | No |
2005-10-01 | Plan funding arrangement – Insurance | Yes |
2005-10-01 | Plan benefit arrangement – Insurance | Yes |
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 16699 |
Policy instance | 3 |
Insurance contract or identification number | 16699 | Number of Individuals Covered | 443 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $291,574 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2926 |
Policy instance | 2 |
Insurance contract or identification number | 2926 | Number of Individuals Covered | 436 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $1,845 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $59,979 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,845 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 492 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $9,519 | Total amount of fees paid to insurance company | USD $1,575 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $302,820 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,745 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1575 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 383 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-10-01 | Total amount of commissions paid to insurance broker | USD $9,122 | Total amount of fees paid to insurance company | USD $2,788 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $223,022 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,122 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2788 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 394 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-10-01 | Total amount of commissions paid to insurance broker | USD $8,847 | Total amount of fees paid to insurance company | USD $2,371 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $191,368 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,847 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2371 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 333 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-10-01 | Total amount of commissions paid to insurance broker | USD $8,652 | Total amount of fees paid to insurance company | USD $1,842 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $147,395 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,652 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1842 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 312 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-10-01 | Total amount of commissions paid to insurance broker | USD $7,847 | Total amount of fees paid to insurance company | USD $1,238 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $98,253 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 241 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-10-01 | Total amount of commissions paid to insurance broker | USD $6,908 | Total amount of fees paid to insurance company | USD $989 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,908 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 989 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GUNN-MOWERY LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 244 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-10-01 | Total amount of commissions paid to insurance broker | USD $6,308 | Total amount of fees paid to insurance company | USD $769 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $67,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,308 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 769 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GUNN-MOWERY LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 196 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-10-01 | Total amount of commissions paid to insurance broker | USD $5,696 | Total amount of fees paid to insurance company | USD $424 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $51,667 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,696 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 424 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GUNN-MOWERY LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 199 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-10-01 | Total amount of commissions paid to insurance broker | USD $6,308 | Total amount of fees paid to insurance company | USD $589 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $68,092 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,308 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 589 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | GUNN-MOWERY LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 195 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-10-01 | Total amount of commissions paid to insurance broker | USD $7,649 | Total amount of fees paid to insurance company | USD $945 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $80,431 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 136540 |
Policy instance | 1 |
Insurance contract or identification number | 136540 | Number of Individuals Covered | 186 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $8,152 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D / EXCESS LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $77,763 |
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