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DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 401k Plan overview

Plan NameDAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN
Plan identification number 502

DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

DAN T. MOORE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:DAN T. MOORE COMPANY
Employer identification number (EIN):341082874
NAIC Classification:325100

Additional information about DAN T. MOORE COMPANY

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1971-01-15
Company Identification Number: 406100
Legal Registered Office Address: 127 PUBLIC SQUARE
SUITE 2700
CLEVELAND
United States of America (USA)
44114

More information about DAN T. MOORE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01NANCY KEENE2023-08-28
5022021-01-01NANCY KEENE
5022020-01-01RON SLATTERY
5022019-01-01RON SLATTERY2020-10-15
5022018-01-01RON SLATTERY2018-09-09
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01
5022012-01-01RON SLATTERY
5022011-01-01RON SLATTERY
5022010-01-01RON SLATTERY
5022009-01-01CHARLES FEDERANICH

Plan Statistics for DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN

401k plan membership statisitcs for DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN

Measure Date Value
2022: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01608
Total number of active participants reported on line 7a of the Form 55002022-01-01536
Total of all active and inactive participants2022-01-01536
Total participants2022-01-01536
2021: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01612
Total number of active participants reported on line 7a of the Form 55002021-01-01608
Total of all active and inactive participants2021-01-01608
Total participants2021-01-01608
2020: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01999
Total number of active participants reported on line 7a of the Form 55002020-01-01612
Total of all active and inactive participants2020-01-01612
Total participants2020-01-01612
2019: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01958
Total number of active participants reported on line 7a of the Form 55002019-01-01999
Total of all active and inactive participants2019-01-01999
Total participants2019-01-01999
2018: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01920
Total number of active participants reported on line 7a of the Form 55002018-01-01958
Total of all active and inactive participants2018-01-01958
Total participants2018-01-01958
2017: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01897
Total number of active participants reported on line 7a of the Form 55002017-01-01920
Total of all active and inactive participants2017-01-01920
Total participants2017-01-01920
2016: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01899
Number of retired or separated participants receiving benefits2016-01-01897
Total of all active and inactive participants2016-01-01897
Total participants2016-01-01897
2015: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01610
Number of retired or separated participants receiving benefits2015-01-01899
Total of all active and inactive participants2015-01-01899
Total participants2015-01-01899
2014: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01356
Total number of active participants reported on line 7a of the Form 55002014-01-01610
Total of all active and inactive participants2014-01-01610
Total participants2014-01-01610
2013: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01350
Total number of active participants reported on line 7a of the Form 55002013-01-01356
Total of all active and inactive participants2013-01-01356
2012: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01178
Total number of active participants reported on line 7a of the Form 55002012-01-01350
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 participants2012-01-01350
2011: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01181
Total number of active participants reported on line 7a of the Form 55002011-01-01178
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 participants2011-01-01178
2010: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01184
Total number of active participants reported on line 7a of the Form 55002010-01-01181
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 participants2010-01-01181
2009: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01292
Total number of active participants reported on line 7a of the Form 55002009-01-01184
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01184

Form 5500 Responses for DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN

2022: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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: DAN T. MOORE COMPANY GROUP LIFE, DISABILITY AND DENTAL INSURANCE 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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered536
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $45,385
Total amount of fees paid to insurance companyUSD $5,298
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $169,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,385
Amount paid for insurance broker fees5298
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered608
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $17,943
Total amount of fees paid to insurance companyUSD $1,506
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $183,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,943
Amount paid for insurance broker fees1506
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered612
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $25,377
Total amount of fees paid to insurance companyUSD $3,348
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $229,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,377
Amount paid for insurance broker fees3348
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered999
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $28,774
Total amount of fees paid to insurance companyUSD $2,307
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $284,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,774
Amount paid for insurance broker fees2307
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered920
Insurance policy start date2016-12-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $24,881
Total amount of fees paid to insurance companyUSD $4,005
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $254,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,881
Amount paid for insurance broker fees4005
Insurance broker organization code?3
Insurance broker nameASSUREX AGENCY INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 1
Insurance contract or identification numberTM05921159
Number of Individuals Covered899
Insurance policy start date2015-12-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $24,153
Total amount of fees paid to insurance companyUSD $9,309
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $224,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,108
Amount paid for insurance broker fees9309
Insurance broker organization code?3
Insurance broker nameASSUREX AGENCY INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05921159
Policy instance 4
Insurance contract or identification numberTM05921159
Number of Individuals Covered610
Insurance policy start date2014-12-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $27
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27
Insurance broker organization code?3
Insurance broker nameJAMES B. OSWALD CO.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147140
Policy instance 3
Insurance contract or identification number10147140
Number of Individuals Covered124
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $3,057
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,057
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100013751
Policy instance 2
Insurance contract or identification number40000100013751
Number of Individuals Covered188
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $9,623
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 providedVOL & DEP AD&D VOL & DEP VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $53,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,623
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147139
Policy instance 1
Insurance contract or identification number10147139
Number of Individuals Covered424
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $3,760
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,760
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147139
Policy instance 1
Insurance contract or identification number10147139
Number of Individuals Covered356
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $3,160
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,160
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100013751
Policy instance 2
Insurance contract or identification number40000100013751
Number of Individuals Covered219
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $8,703
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 providedVOL & DEP AD&D VOL & DEP VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $52,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,703
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147140
Policy instance 3
Insurance contract or identification number10147140
Number of Individuals Covered118
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $3,035
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,035
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147140
Policy instance 3
Insurance contract or identification number10147140
Number of Individuals Covered127
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $2,606
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,606
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100013751
Policy instance 2
Insurance contract or identification number40000100013751
Number of Individuals Covered216
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $7,458
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 providedVOL & DEP AD&D VOL & DEP VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $49,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,458
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10147139
Policy instance 1
Insurance contract or identification number10147139
Number of Individuals Covered350
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $2,738
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,738
Insurance broker organization code?3
Insurance broker nameTHE JAMES B. OSWALD COMPANY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5396744
Policy instance 1
Insurance contract or identification number5396744
Number of Individuals Covered178
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $13,745
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 providedVOL AD&D VOL & DEP VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $109,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5396744
Policy instance 1
Insurance contract or identification number5396744
Number of Individuals Covered181
Insurance policy start date2009-12-01
Insurance policy end date2010-11-30
Total amount of commissions paid to insurance brokerUSD $13,498
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 providedVOL AD&D VOL & DEP VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $104,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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