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MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameMCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    MCCOY - ROCKFORD, INC. has sponsored the creation of one or more 401k plans.

    Company Name:MCCOY - ROCKFORD, INC.
    Employer identification number (EIN):274402329
    NAIC Classification:423200

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012021-01-01
    5012020-01-01RACHEL CROUCHET2020-05-28
    5012019-01-01RACHEL CROUCHET2020-04-15
    5012018-01-01
    5012017-01-01
    5012016-01-01
    5012015-01-01RACHEL CROUCHET
    5012014-01-01DAVID S BARNETT
    5012013-01-01DAVID BARNETT
    5012012-01-01DAVID BARNETT
    5012011-01-01DAVID BARNETT
    5012010-01-01DAVID BARNETT

    Plan Statistics for MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN

    Measure Date Value
    2021: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2021 401k membership
    Total participants, beginning-of-year2021-01-01180
    Total number of active participants reported on line 7a of the Form 55002021-01-01154
    Total of all active and inactive participants2021-01-01154
    Total participants2021-01-01154
    2020: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2020 401k membership
    Total participants, beginning-of-year2020-01-01209
    Total number of active participants reported on line 7a of the Form 55002020-01-01173
    Number of retired or separated participants receiving benefits2020-01-017
    Number of other retired or separated participants entitled to future benefits2020-01-010
    Total of all active and inactive participants2020-01-01180
    2019: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2019 401k membership
    Total participants, beginning-of-year2019-01-01195
    Total number of active participants reported on line 7a of the Form 55002019-01-01209
    Number of retired or separated participants receiving benefits2019-01-010
    Number of other retired or separated participants entitled to future benefits2019-01-010
    Total of all active and inactive participants2019-01-01209
    Number of employers contributing to the scheme2019-01-010
    2018: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2018 401k membership
    Total participants, beginning-of-year2018-01-01222
    Total number of active participants reported on line 7a of the Form 55002018-01-01195
    Number of retired or separated participants receiving benefits2018-01-010
    Number of other retired or separated participants entitled to future benefits2018-01-010
    Total of all active and inactive participants2018-01-01195
    Number of employers contributing to the scheme2018-01-010
    2017: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2017 401k membership
    Total participants, beginning-of-year2017-01-01231
    Total number of active participants reported on line 7a of the Form 55002017-01-01222
    Number of retired or separated participants receiving benefits2017-01-010
    Number of other retired or separated participants entitled to future benefits2017-01-010
    Total of all active and inactive participants2017-01-01222
    2016: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2016 401k membership
    Total participants, beginning-of-year2016-01-01246
    Total number of active participants reported on line 7a of the Form 55002016-01-01194
    Number of retired or separated participants receiving benefits2016-01-017
    Number of other retired or separated participants entitled to future benefits2016-01-012
    Total of all active and inactive participants2016-01-01203
    2015: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2015 401k membership
    Total participants, beginning-of-year2015-01-01280
    Total number of active participants reported on line 7a of the Form 55002015-01-01282
    Number of retired or separated participants receiving benefits2015-01-012
    Number of other retired or separated participants entitled to future benefits2015-01-010
    Total of all active and inactive participants2015-01-01284
    2014: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2014 401k membership
    Total participants, beginning-of-year2014-01-01256
    Total number of active participants reported on line 7a of the Form 55002014-01-01280
    Number of retired or separated participants receiving benefits2014-01-010
    Number of other retired or separated participants entitled to future benefits2014-01-010
    Total of all active and inactive participants2014-01-01280
    2013: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2013 401k membership
    Total participants, beginning-of-year2013-01-01247
    Total number of active participants reported on line 7a of the Form 55002013-01-01254
    Number of retired or separated participants receiving benefits2013-01-012
    Number of other retired or separated participants entitled to future benefits2013-01-010
    Total of all active and inactive participants2013-01-01256
    2012: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2012 401k membership
    Total participants, beginning-of-year2012-01-01295
    Total number of active participants reported on line 7a of the Form 55002012-01-01279
    Number of retired or separated participants receiving benefits2012-01-010
    Number of other retired or separated participants entitled to future benefits2012-01-010
    Total of all active and inactive participants2012-01-01279
    2011: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2011 401k membership
    Total participants, beginning-of-year2011-01-01241
    Total number of active participants reported on line 7a of the Form 55002011-01-01295
    Number of retired or separated participants receiving benefits2011-01-010
    Number of other retired or separated participants entitled to future benefits2011-01-010
    Total of all active and inactive participants2011-01-01295
    2010: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2010 401k membership
    Total participants, beginning-of-year2010-01-01100
    Total number of active participants reported on line 7a of the Form 55002010-01-01241
    Number of retired or separated participants receiving benefits2010-01-010
    Number of other retired or separated participants entitled to future benefits2010-01-010
    Total of all active and inactive participants2010-01-01241

    Form 5500 Responses for MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN

    2021: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Submission has been amendedNo
    2021-01-01This submission is the final filingNo
    2021-01-01This return/report is a short plan year return/report (less than 12 months)No
    2021-01-01Plan is a collectively bargained planNo
    2021-01-01Plan funding arrangement – InsuranceYes
    2021-01-01Plan funding arrangement – General assets of the sponsorYes
    2021-01-01Plan benefit arrangement – InsuranceYes
    2021-01-01Plan benefit arrangement – General assets of the sponsorYes
    2020: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
    2020-01-01Type of plan entitySingle employer plan
    2020-01-01Submission has been amendedNo
    2020-01-01This submission is the final filingNo
    2020-01-01This return/report is a short plan year return/report (less than 12 months)No
    2020-01-01Plan is a collectively bargained planNo
    2020-01-01Plan funding arrangement – InsuranceYes
    2020-01-01Plan funding arrangement – General assets of the sponsorYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement – General assets of the sponsorYes
    2019: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2019 form 5500 responses
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE 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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE 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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    2016-01-01This submission is the final filingNo
    2016-01-01This return/report is a short plan year return/report (less than 12 months)No
    2016-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Submission has been amendedNo
    2015-01-01This submission is the final filingNo
    2015-01-01This return/report is a short plan year return/report (less than 12 months)No
    2015-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2014 form 5500 responses
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Submission has been amendedNo
    2014-01-01This submission is the final filingNo
    2014-01-01This return/report is a short plan year return/report (less than 12 months)No
    2014-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    2013-01-01This submission is the final filingNo
    2013-01-01This return/report is a short plan year return/report (less than 12 months)No
    2013-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2012 form 5500 responses
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    2012-01-01This submission is the final filingNo
    2012-01-01This return/report is a short plan year return/report (less than 12 months)No
    2012-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2011 form 5500 responses
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    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: MCCOY - ROCKFORD, INC. HEALTH AND WELFARE PLAN 2010 form 5500 responses
    2010-01-01Type of plan entitySingle employer plan
    2010-01-01First time form 5500 has been submittedYes
    2010-01-01Submission has been amendedNo
    2010-01-01This submission is the final filingNo
    2010-01-01This return/report is a short plan year return/report (less than 12 months)No
    2010-01-01Plan is a collectively bargained planNo
    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

    Insurance Providers Used on plan

    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000BTVR
    Policy instance 4
    Insurance contract or identification numberG000BTVR
    Number of Individuals Covered119
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $22,106
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    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 CarrierUSD $195,727
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,112
    Insurance broker organization code?3
    PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
    Policy contract number0010655912
    Policy instance 1
    Insurance contract or identification number0010655912
    Number of Individuals Covered20
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $370
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $7,644
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $255
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract numberR0594440
    Policy instance 2
    Insurance contract or identification numberR0594440
    Number of Individuals Covered29
    Insurance policy start date2021-01-01
    Insurance policy end date3021-12-31
    Total amount of commissions paid to insurance brokerUSD $302
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedCRITICAL ILLNESS
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $8,023
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $236
    Insurance broker organization code?3
    BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
    Policy contract numberEMC L21100865
    Policy instance 3
    Insurance contract or identification numberEMC L21100865
    Number of Individuals Covered133
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedSTOP LOSS
    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
    BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 0917 )
    Policy contract number272155
    Policy instance 4
    Insurance contract or identification number272155
    Number of Individuals Covered266
    Insurance policy start date2019-09-01
    Insurance policy end date2020-05-31
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,332,697
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
    Policy contract number005727
    Policy instance 3
    Insurance contract or identification number005727
    Number of Individuals Covered173
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $32,091
    Total amount of fees paid to insurance companyUSD $11,589
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    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 CarrierUSD $231,659
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $24,787
    Amount paid for insurance broker fees11589
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
    Policy contract number10655912
    Policy instance 2
    Insurance contract or identification number10655912
    Number of Individuals Covered27
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $422
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $8,716
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $292
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number10655912
    Policy instance 1
    Insurance contract or identification number10655912
    Number of Individuals Covered33
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $773
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedCRITICAL ILLNESS
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $8,863
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $507
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number10655912
    Policy instance 1
    Insurance contract or identification number10655912
    Number of Individuals Covered36
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $1,165
    Total amount of fees paid to insurance companyUSD $2
    Other welfare benefits providedCRITICAL ILLNESS
    Welfare Benefit Premiums Paid to CarrierUSD $11,794
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $788
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
    Policy contract number10655912
    Policy instance 2
    Insurance contract or identification number10655912
    Number of Individuals Covered28
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $520
    Total amount of fees paid to insurance companyUSD $1
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $10,486
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $355
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 3
    Insurance contract or identification number742711
    Number of Individuals Covered323
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $22,672
    Total amount of fees paid to insurance companyUSD $3,801
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
    Welfare Benefit Premiums Paid to CarrierUSD $2,049,083
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,726
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerBONUS
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract numberR0594440
    Policy instance 1
    Insurance contract or identification numberR0594440
    Number of Individuals Covered54
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $1,415
    Total amount of fees paid to insurance companyUSD $8
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedCRITICAL ILLNESS
    Welfare Benefit Premiums Paid to CarrierUSD $13,677
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $928
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 2
    Insurance contract or identification number742711
    Number of Individuals Covered318
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $20,986
    Total amount of fees paid to insurance companyUSD $1,001
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
    Welfare Benefit Premiums Paid to CarrierUSD $1,998,321
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,262
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerBONUS
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 3
    Insurance contract or identification number742711
    Number of Individuals Covered356
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $21,821
    Total amount of fees paid to insurance companyUSD $1,136
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
    Welfare Benefit Premiums Paid to CarrierUSD $2,016,014
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,764
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker nameUSI SOUTHWEST, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract numberR0594440
    Policy instance 2
    Insurance contract or identification numberR0594440
    Number of Individuals Covered52
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $2,547
    Total amount of fees paid to insurance companyUSD $120
    Other welfare benefits providedCRITICAL ILLNESS
    Welfare Benefit Premiums Paid to CarrierUSD $16,586
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,782
    Amount paid for insurance broker fees93
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameUSI SOUTHWEST, INC.
    PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
    Policy contract number10655912
    Policy instance 1
    Insurance contract or identification number10655912
    Number of Individuals Covered45
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $1,653
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $13,318
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,157
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameUSI SOUTHWEST, INC.
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 1
    Insurance contract or identification number742711
    Number of Individuals Covered485
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $2,647
    Total amount of fees paid to insurance companyUSD $10,344
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $2,097,196
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,647
    Amount paid for insurance broker fees10344
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number214155
    Policy instance 2
    Insurance contract or identification number214155
    Number of Individuals Covered282
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $15,927
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $100,184
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,390
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 2
    Insurance contract or identification number742711
    Number of Individuals Covered500
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $13,058
    Total amount of fees paid to insurance companyUSD $2,569
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,804,917
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,058
    Amount paid for insurance broker fees2569
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameUSI INSURANCE SERVICES, LLC
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number214155
    Policy instance 1
    Insurance contract or identification number214155
    Number of Individuals Covered280
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $21,673
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $138,253
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $21,673
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 3
    Insurance contract or identification number742711
    Number of Individuals Covered388
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,504,799
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberKM05994192
    Policy instance 1
    Insurance contract or identification numberKM05994192
    Number of Individuals Covered616
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $17,126
    Total amount of fees paid to insurance companyUSD $3,719
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $91,352
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,126
    Amount paid for insurance broker fees3719
    Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number214155
    Policy instance 2
    Insurance contract or identification number214155
    Number of Individuals Covered281
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $20,329
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $130,942
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,329
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number214155
    Policy instance 2
    Insurance contract or identification number214155
    Number of Individuals Covered279
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $17,820
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $115,258
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,820
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number567048
    Policy instance 1
    Insurance contract or identification number567048
    Number of Individuals Covered222
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $19,688
    Total amount of fees paid to insurance companyUSD $4,559
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $131,793
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,688
    Amount paid for insurance broker fees4559
    Additional information about fees paid to insurance brokerVOLUME INCENTIVES
    Insurance broker organization code?3
    Insurance broker nameANCO INSURANCE SERVICES CORPORATION
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number742711
    Policy instance 3
    Insurance contract or identification number742711
    Number of Individuals Covered414
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,285,214
    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 number214155
    Policy instance 4
    Insurance contract or identification number214155
    Number of Individuals Covered295
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $17,603
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $110,238
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
    Policy contract numberUS324608
    Policy instance 1
    Insurance contract or identification numberUS324608
    Number of Individuals Covered420
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,021,847
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number600410
    Policy instance 2
    Insurance contract or identification number600410
    Number of Individuals Covered101
    Insurance policy start date2010-03-01
    Insurance policy end date2011-02-28
    Total amount of commissions paid to insurance brokerUSD $4,049
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $34,627
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
    Policy contract number567048
    Policy instance 3
    Insurance contract or identification number567048
    Number of Individuals Covered227
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $15,889
    Total amount of fees paid to insurance companyUSD $1,276
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $122,625
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
    Policy contract numberH65087
    Policy instance 4
    Insurance contract or identification numberH65087
    Number of Individuals Covered241
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $21,983
    Total amount of fees paid to insurance companyUSD $9,826
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $271,503
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,779
    Amount paid for insurance broker fees6395
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameNFP CORPORATE SERVICES
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number621778
    Policy instance 2
    Insurance contract or identification number621778
    Number of Individuals Covered240
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $6,920
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $677,223
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,920
    Insurance broker organization code?3
    Insurance broker nameCOMPASS CONSULTING AND BENEFITS
    AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
    Policy contract numberUS324608
    Policy instance 1
    Insurance contract or identification numberUS324608
    Number of Individuals Covered167
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $4,626
    Total amount of fees paid to insurance companyUSD $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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $448,747
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,626
    Insurance broker organization code?3
    Insurance broker nameCOMPASS CONSULTING AND BENEFITS
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number600410
    Policy instance 3
    Insurance contract or identification number600410
    Number of Individuals Covered102
    Insurance policy start date2009-03-01
    Insurance policy end date2010-02-28
    Total amount of commissions paid to insurance brokerUSD $6,797
    Total amount of fees paid to insurance companyUSD $308
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $39,042
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,114
    Amount paid for insurance broker fees308
    Additional information about fees paid to insurance brokerPM CROSS-SALE
    Insurance broker organization code?3
    Insurance broker nameROGERS BENEFIT GROUP INC.

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