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PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePHOENIX CONTACT, INC. WELFARE BENEFIT PLAN
Plan identification number 501

PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

PHOENIX CONTACT SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:PHOENIX CONTACT SERVICES, INC.
Employer identification number (EIN):251389944
NAIC Classification:423600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-01-01RYAN DOUGHERTY2019-07-30
5012017-01-01
5012016-01-01JOEL NESS
5012015-01-01JOEL NESS
5012014-01-01JOEL NESS
5012013-01-01JOEL NESS
5012012-01-01JOEL NESS
5012011-01-01JOEL NESS
5012010-01-01JOEL NESS
5012009-01-01JOEL A NESS

Plan Statistics for PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN

Measure Date Value
2018: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01728
Total number of active participants reported on line 7a of the Form 55002018-01-01799
Number of retired or separated participants receiving benefits2018-01-014
Number of other retired or separated participants entitled to future benefits2018-01-016
Total of all active and inactive participants2018-01-01809
2017: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01681
Total number of active participants reported on line 7a of the Form 55002017-01-01715
Number of retired or separated participants receiving benefits2017-01-015
Number of other retired or separated participants entitled to future benefits2017-01-018
Total of all active and inactive participants2017-01-01728
2016: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01678
Total number of active participants reported on line 7a of the Form 55002016-01-01676
Number of retired or separated participants receiving benefits2016-01-012
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-01681
Total participants2016-01-01681
2015: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01662
Total number of active participants reported on line 7a of the Form 55002015-01-01671
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-015
Total of all active and inactive participants2015-01-01678
Total participants2015-01-01678
2014: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01646
Total number of active participants reported on line 7a of the Form 55002014-01-01653
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-01662
Total participants2014-01-01662
2013: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01610
Total number of active participants reported on line 7a of the Form 55002013-01-01646
Number of retired or separated participants receiving benefits2013-01-012
Number of other retired or separated participants entitled to future benefits2013-01-014
Total of all active and inactive participants2013-01-01652
2012: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01533
Total number of active participants reported on line 7a of the Form 55002012-01-01588
Number of retired or separated participants receiving benefits2012-01-013
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-01596
2011: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01501
Total number of active participants reported on line 7a of the Form 55002011-01-01521
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-01523
2010: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01516
Total number of active participants reported on line 7a of the Form 55002010-01-01501
Number of retired or separated participants receiving benefits2010-01-012
Number of other retired or separated participants entitled to future benefits2010-01-011
Total of all active and inactive participants2010-01-01504
2009: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01525
Total number of active participants reported on line 7a of the Form 55002009-01-01516
Total of all active and inactive participants2009-01-01516

Form 5500 Responses for PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN

2018: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: PHOENIX CONTACT, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 5
Insurance contract or identification number071454
Number of Individuals Covered893
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $750,237
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 number00526443
Policy instance 4
Insurance contract or identification number00526443
Number of Individuals Covered662
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,298
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
Commission paid to Insurance BrokerUSD $1,298
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1710
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $178,155
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,089,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $178,155
Insurance broker organization code?3
Insurance broker nameALERA GROUP INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-103145
Policy instance 2
Insurance contract or identification numberETB-103145
Number of Individuals Covered715
Insurance policy start date2016-10-15
Insurance policy end date2017-10-14
Total amount of commissions paid to insurance brokerUSD $852
Total amount of fees paid to insurance companyUSD $1,065
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $5,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1065
Additional information about fees paid to insurance brokerGENERAL AGENT FEES AND BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $852
Insurance broker nameUSI/WELLS FARGO INSURANCE SERVICES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered675
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $74,270
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 $551,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,126
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-103145
Policy instance 2
Insurance contract or identification numberETB-103145
Number of Individuals Covered653
Insurance policy start date2014-10-15
Insurance policy end date2015-10-14
Total amount of commissions paid to insurance brokerUSD $861
Total amount of fees paid to insurance companyUSD $976
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $5,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $861
Insurance broker organization code?3
Amount paid for insurance broker fees976
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker nameREUBEN WARNER ASSOCIATES
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1690
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $89,078
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,965,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,078
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered985
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Welfare Benefit Premiums Paid to CarrierUSD $789,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberPCS-001
Policy instance 5
Insurance contract or identification numberPCS-001
Number of Individuals Covered1705
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,335
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,335
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered654
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $43,879
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 $438,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,879
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered653
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $42,333
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 $423,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,333
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-103145
Policy instance 2
Insurance contract or identification numberETB-103145
Number of Individuals Covered661
Insurance policy start date2013-10-15
Insurance policy end date2014-10-15
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $1,063
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $938
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker nameREUBEN WARNER ASSOCIATES
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1618
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $89,078
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,020,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,078
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered1012
Insurance policy start date2014-01-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $827,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberPCS-001
Policy instance 5
Insurance contract or identification numberPCS-001
Number of Individuals Covered1630
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,240
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,240
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered614
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $38,692
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 $386,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,692
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB103145
Policy instance 2
Insurance contract or identification numberETB103145
Number of Individuals Covered648
Insurance policy start date2012-10-15
Insurance policy end date2013-10-14
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $1,063
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1063
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $938
Insurance broker nameWELLS FARGO INS SVCS INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1610
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $89,078
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 $5,584,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,078
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered1193
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 $881,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberPCS-001
Policy instance 5
Insurance contract or identification numberPCS-001
Number of Individuals Covered1606
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,151
Total amount of fees paid to insurance companyUSD $2,589
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 $57,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,151
Amount paid for insurance broker fees2589
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB103145
Policy instance 2
Insurance contract or identification numberETB103145
Number of Individuals Covered640
Insurance policy start date2011-10-15
Insurance policy end date2012-10-14
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $1,063
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1063
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $938
Insurance broker nameWELLS FARGO INS SVCS INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1552
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $81,050
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 $4,570,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,050
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered1256
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 $891,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberPCS-001
Policy instance 5
Insurance contract or identification numberPCS-001
Number of Individuals Covered1546
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,029
Total amount of fees paid to insurance companyUSD $2,314
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 $51,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,029
Amount paid for insurance broker fees2314
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered581
Insurance policy start date2011-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $29,041
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 $290,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,041
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberPCS-001
Policy instance 5
Insurance contract or identification numberPCS-001
Number of Individuals Covered1251
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $907
Total amount of fees paid to insurance companyUSD $2,041
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 $45,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered495
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $26,909
Total amount of fees paid to insurance companyUSD $1,427
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 $269,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB103145
Policy instance 2
Insurance contract or identification numberETB103145
Number of Individuals Covered550
Insurance policy start date2010-10-15
Insurance policy end date2011-10-15
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $1,063
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $6,255
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 number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1402
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $91,801
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 $4,319,914
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 number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered1234
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 $842,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33141
Policy instance 1
Insurance contract or identification number33141
Number of Individuals Covered512
Insurance policy start date2009-03-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $27,008
Total amount of fees paid to insurance companyUSD $5,394
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 $270,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,008
Amount paid for insurance broker fees5394
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION PROGRAM
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB103145
Policy instance 2
Insurance contract or identification numberETB103145
Number of Individuals Covered516
Insurance policy start date2009-10-15
Insurance policy end date2010-10-15
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $1,063
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $6,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1063
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $938
Insurance broker nameWELLS FARGO INS SVCS INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 4
Insurance contract or identification number071454
Number of Individuals Covered1125
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,657
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 $732,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,657
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number06-1041332
Policy instance 5
Insurance contract or identification number06-1041332
Number of Individuals Covered1237
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $812
Total amount of fees paid to insurance companyUSD $1,826
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 $40,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $812
Amount paid for insurance broker fees1826
Additional information about fees paid to insurance brokerINSURANCE FEES
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number071454
Policy instance 3
Insurance contract or identification number071454
Number of Individuals Covered1233
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $69,992
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 $3,497,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,992
Insurance broker organization code?3
Insurance broker nameAMERICAN INSURANCE ADMINISTRATORS,

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