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FIRST UROLOGY, PSC WELFARE PLAN 401k Plan overview

Plan NameFIRST UROLOGY, PSC WELFARE PLAN
Plan identification number 501

FIRST UROLOGY, PSC WELFARE PLAN Benefits

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

401k Sponsoring company profile

FIRST UROLOGY PSC has sponsored the creation of one or more 401k plans.

Company Name:FIRST UROLOGY PSC
Employer identification number (EIN):351488175
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST UROLOGY, PSC WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01WILLIAM BONDS2023-01-23
5012020-07-01WILLIAM BONDS2022-04-12
5012019-07-01
5012018-07-01
5012017-07-01
5012016-07-01MARK REYNOLDS
5012015-07-01MARK REYNOLDS
5012014-07-01MARK REYNOLDS
5012013-07-01MARK REYNOLDS
5012012-07-01MARK REYNOLDS
5012011-07-01MARK REYNOLDS
5012009-07-01MICHAEL SHANNON
5012008-07-01MICHAEL SHANNON

Plan Statistics for FIRST UROLOGY, PSC WELFARE PLAN

401k plan membership statisitcs for FIRST UROLOGY, PSC WELFARE PLAN

Measure Date Value
2021: FIRST UROLOGY, PSC WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01298
Total number of active participants reported on line 7a of the Form 55002021-07-01323
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01323
2020: FIRST UROLOGY, PSC WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01270
Total number of active participants reported on line 7a of the Form 55002020-07-01298
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01298
2019: FIRST UROLOGY, PSC WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01287
Total number of active participants reported on line 7a of the Form 55002019-07-01269
Number of retired or separated participants receiving benefits2019-07-011
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01270
2018: FIRST UROLOGY, PSC WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01323
Total number of active participants reported on line 7a of the Form 55002018-07-01321
Number of retired or separated participants receiving benefits2018-07-011
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01322
2017: FIRST UROLOGY, PSC WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01236
Total number of active participants reported on line 7a of the Form 55002017-07-01279
Total of all active and inactive participants2017-07-01279
2016: FIRST UROLOGY, PSC WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01266
Total number of active participants reported on line 7a of the Form 55002016-07-01236
Total of all active and inactive participants2016-07-01236
2015: FIRST UROLOGY, PSC WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01264
Total number of active participants reported on line 7a of the Form 55002015-07-01266
Number of retired or separated participants receiving benefits2015-07-010
Total of all active and inactive participants2015-07-01266
2014: FIRST UROLOGY, PSC WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01253
Total number of active participants reported on line 7a of the Form 55002014-07-01247
Total of all active and inactive participants2014-07-01247
2013: FIRST UROLOGY, PSC WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01212
Total number of active participants reported on line 7a of the Form 55002013-07-01303
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01303
2012: FIRST UROLOGY, PSC WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01303
Total number of active participants reported on line 7a of the Form 55002012-07-01300
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01300
2011: FIRST UROLOGY, PSC WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01247
Total number of active participants reported on line 7a of the Form 55002011-07-01303
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01303
2009: FIRST UROLOGY, PSC WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01101
Total number of active participants reported on line 7a of the Form 55002009-07-01108
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01108
Total participants2009-07-010
2008: FIRST UROLOGY, PSC WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-07-01117
Total number of active participants reported on line 7a of the Form 55002008-07-01101
Number of retired or separated participants receiving benefits2008-07-010
Number of other retired or separated participants entitled to future benefits2008-07-010
Total of all active and inactive participants2008-07-01101

Form 5500 Responses for FIRST UROLOGY, PSC WELFARE PLAN

2021: FIRST UROLOGY, PSC WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: FIRST UROLOGY, PSC WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: FIRST UROLOGY, PSC WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: FIRST UROLOGY, PSC WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: FIRST UROLOGY, PSC WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: FIRST UROLOGY, PSC WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: FIRST UROLOGY, PSC WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: FIRST UROLOGY, PSC WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: FIRST UROLOGY, PSC WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: FIRST UROLOGY, PSC WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: FIRST UROLOGY, PSC WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: FIRST UROLOGY, PSC WELFARE PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes
2008: FIRST UROLOGY, PSC WELFARE PLAN 2008 form 5500 responses
2008-07-01Type of plan entitySingle employer plan
2008-07-01Submission has been amendedNo
2008-07-01This submission is the final filingNo
2008-07-01This return/report is a short plan year return/report (less than 12 months)No
2008-07-01Plan is a collectively bargained planNo
2008-07-01Plan funding arrangement – InsuranceYes
2008-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 3
Insurance contract or identification numberLK964217
Number of Individuals Covered323
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $35,098
Total amount of fees paid to insurance companyUSD $6,106
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $233,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,098
Amount paid for insurance broker fees6106
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 1
Insurance contract or identification numberFLX966138
Number of Individuals Covered454
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $8,415
Total amount of fees paid to insurance companyUSD $1,374
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $44,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,415
Amount paid for insurance broker fees1374
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC960796
Policy instance 2
Insurance contract or identification numberHC960796
Number of Individuals Covered1
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $125
Total amount of fees paid to insurance companyUSD $60
Other welfare benefits providedVOLUNTARY HOSPITAL CARE
Welfare Benefit Premiums Paid to CarrierUSD $626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number846239
Policy instance 4
Insurance contract or identification number846239
Number of Individuals Covered181
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $55,551
Total amount of fees paid to insurance companyUSD $7,072
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,595,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,663
Amount paid for insurance broker fees7072
Additional information about fees paid to insurance brokerBONUS COMPENSATION
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 5
Insurance contract or identification numberE7964802
Number of Individuals Covered2
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $39
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 6
Insurance contract or identification numberOK967684
Number of Individuals Covered451
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $1,441
Total amount of fees paid to insurance companyUSD $177
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,441
Amount paid for insurance broker fees177
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 7
Insurance contract or identification numberVDT961657
Number of Individuals Covered145
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $11,455
Total amount of fees paid to insurance companyUSD $1,448
Other welfare benefits providedVOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $57,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,455
Amount paid for insurance broker fees1448
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW13121
Policy instance 8
Insurance contract or identification numberW13121
Number of Individuals Covered325
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $12,911
Total amount of fees paid to insurance companyUSD $5,496
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,568
Amount paid for insurance broker fees2499
Additional information about fees paid to insurance brokerBONUS COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI961443
Policy instance 9
Insurance contract or identification numberCI961443
Number of Individuals Covered60
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $4,461
Total amount of fees paid to insurance companyUSD $1,034
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $22,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,461
Amount paid for insurance broker fees1034
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberAI961517
Policy instance 10
Insurance contract or identification numberAI961517
Number of Individuals Covered93
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $2,927
Total amount of fees paid to insurance companyUSD $626
Other welfare benefits providedACCIDENTAL INJURY
Welfare Benefit Premiums Paid to CarrierUSD $14,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,927
Amount paid for insurance broker fees626
Additional information about fees paid to insurance brokerOVERRIDE FEE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC960796
Policy instance 3
Insurance contract or identification numberHC960796
Number of Individuals Covered4
Insurance policy start date2020-06-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $203
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY HOSPITAL CARE
Welfare Benefit Premiums Paid to CarrierUSD $1,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $203
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 2
Insurance contract or identification numberOK967684
Number of Individuals Covered377
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $1,288
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,288
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberAI961517
Policy instance 1
Insurance contract or identification numberAI961517
Number of Individuals Covered109
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $2,391
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL INJURY
Welfare Benefit Premiums Paid to CarrierUSD $11,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,391
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 4
Insurance contract or identification numberLK964217
Number of Individuals Covered298
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $36,434
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $210,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,434
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 5
Insurance contract or identification numberE7964802
Number of Individuals Covered2
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $36
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 6
Insurance contract or identification numberVDT961657
Number of Individuals Covered119
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $11,012
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $47,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,012
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 7
Insurance contract or identification numberFLX966138
Number of Individuals Covered396
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $45,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI961443
Policy instance 8
Insurance contract or identification numberCI961443
Number of Individuals Covered104
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $4,118
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $20,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,118
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW13121
Policy instance 9
Insurance contract or identification numberW13121
Number of Individuals Covered345
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $33,596
Total amount of fees paid to insurance companyUSD $4,528
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,743,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,919
Amount paid for insurance broker fees4528
Additional information about fees paid to insurance brokerBONUS COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 1
Insurance contract or identification numberOK967684
Number of Individuals Covered480
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $1,009
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,009
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 2
Insurance contract or identification number00250191
Number of Individuals Covered304
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $218
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $126
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 3
Insurance contract or identification numberE7964802
Number of Individuals Covered3
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $39
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 4
Insurance contract or identification numberLK964217
Number of Individuals Covered282
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $27,328
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $198,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,328
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 5
Insurance contract or identification numberVDT961657
Number of Individuals Covered121
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $8,992
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $48,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,992
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 6
Insurance contract or identification numberFLX966138
Number of Individuals Covered542
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $8,019
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $45,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,019
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 7
Insurance contract or identification number00250191
Number of Individuals Covered311
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $14,334
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,743,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,282
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number928276
Policy instance 8
Insurance contract or identification number928276
Number of Individuals Covered26
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $3,940
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEE ACCIDENT & CANCER; EE-SP-CHD CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $19,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,940
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number941804
Policy instance 9
Insurance contract or identification number941804
Number of Individuals Covered177
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $9,802
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,802
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 1
Insurance contract or identification numberVDT961657
Number of Individuals Covered121
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $10,110
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,110
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 2
Insurance contract or identification numberE7964802
Number of Individuals Covered3
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $42
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 3
Insurance contract or identification numberOK967684
Number of Individuals Covered482
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $1,075
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,075
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number4054003
Policy instance 4
Insurance contract or identification number4054003
Number of Individuals Covered80
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $4,401
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CANCER AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $22,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,401
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number767501
Policy instance 5
Insurance contract or identification number767501
Number of Individuals Covered180
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $3,562
Total amount of fees paid to insurance companyUSD $1,402
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,562
Insurance broker organization code?3
Amount paid for insurance broker fees1402
Additional information about fees paid to insurance brokerBONUS PAID
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 6
Insurance contract or identification number00250191
Number of Individuals Covered308
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $2,904
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,904
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 8
Insurance contract or identification numberLK964217
Number of Individuals Covered280
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $29,468
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,468
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 7
Insurance contract or identification numberFLX966138
Number of Individuals Covered547
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $8,785
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $45,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,785
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 9
Insurance contract or identification number00250191
Number of Individuals Covered317
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $4,759
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,540,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,759
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 8
Insurance contract or identification numberOK967684
Number of Individuals Covered277
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $967
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 7
Insurance contract or identification numberFLX966138
Number of Individuals Covered274
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $7,641
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $39,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 6
Insurance contract or identification number00250191
Number of Individuals Covered301
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $444
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number767501
Policy instance 5
Insurance contract or identification number767501
Number of Individuals Covered179
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $3,389
Total amount of fees paid to insurance companyUSD $2,757
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 4
Insurance contract or identification numberE7964802
Number of Individuals Covered3
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $42
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 2
Insurance contract or identification numberLK964217
Number of Individuals Covered279
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $27,250
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $181,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 3
Insurance contract or identification numberVDT961657
Number of Individuals Covered125
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $10,704
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00250191
Policy instance 1
Insurance contract or identification number00250191
Number of Individuals Covered296
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $24,198
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,277,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 8
Insurance contract or identification numberVDT961657
Number of Individuals Covered95
Insurance policy start date2014-09-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $5,493
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,493
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454555
Policy instance 7
Insurance contract or identification number5454555
Number of Individuals Covered142
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $4,933
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,933
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961657
Policy instance 6
Insurance contract or identification numberVDT961657
Number of Individuals Covered121
Insurance policy start date2015-07-02
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $10,092
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,092
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 5
Insurance contract or identification numberOK967684
Number of Individuals Covered208
Insurance policy start date2014-09-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $523
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $523
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 4
Insurance contract or identification numberLK964217
Number of Individuals Covered236
Insurance policy start date2015-07-02
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $19,437
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,437
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964217
Policy instance 2
Insurance contract or identification numberLK964217
Number of Individuals Covered208
Insurance policy start date2014-09-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $11,528
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,528
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK967684
Policy instance 1
Insurance contract or identification numberOK967684
Number of Individuals Covered236
Insurance policy start date2015-07-02
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $968
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $5,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $968
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 9
Insurance contract or identification numberE7964802
Number of Individuals Covered2
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $36
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9
Insurance broker organization code?3
Insurance broker nameLISA GRAVES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 10
Insurance contract or identification numberFLX966138
Number of Individuals Covered236
Insurance policy start date2015-07-02
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $6,314
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,314
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number584370
Policy instance 3
Insurance contract or identification number584370
Number of Individuals Covered122
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,625
Total amount of fees paid to insurance companyUSD $2,630
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,618
Amount paid for insurance broker fees2630
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00244346
Policy instance 13
Insurance contract or identification number00244346
Number of Individuals Covered238
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $35,941
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $987,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,941
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454555
Policy instance 12
Insurance contract or identification number5454555
Number of Individuals Covered139
Insurance policy start date2015-09-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $3,207
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,207
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966138
Policy instance 11
Insurance contract or identification numberFLX966138
Number of Individuals Covered208
Insurance policy start date2014-09-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $3,399
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $17,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,399
Insurance broker organization code?3
Insurance broker nameWILLIAM PATRICK SHANNON
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5439984
Policy instance 2
Insurance contract or identification number5439984
Number of Individuals Covered125
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $10,942
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $72,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,942
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5299478
Policy instance 1
Insurance contract or identification number5299478
Number of Individuals Covered234
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $15,763
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $144,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,763
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number584370
Policy instance 3
Insurance contract or identification number584370
Number of Individuals Covered125
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $47,460
Total amount of fees paid to insurance companyUSD $13,216
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,157,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,460
Amount paid for insurance broker fees13216
Additional information about fees paid to insurance brokerVOLUME INCENTIVE
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST INC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 5
Insurance contract or identification numberE7964802
Number of Individuals Covered2
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $894
Total amount of fees paid to insurance companyUSD $35
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $258
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameSUZANNE BRATTON TUCKER
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454555
Policy instance 4
Insurance contract or identification number5454555
Number of Individuals Covered155
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $5,248
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,248
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number584370
Policy instance 6
Insurance contract or identification number584370
Number of Individuals Covered127
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,875
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,875
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST INC - LOUISVILLE
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 1
Insurance contract or identification numberE7964802
Number of Individuals Covered60
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $10,427
Total amount of fees paid to insurance companyUSD $563
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,013
Amount paid for insurance broker fees372
Additional information about fees paid to insurance brokerBONUSES AND NON CASH INCENTIVES
Insurance broker organization code?3
Insurance broker nameSUZANNE BRATTON TUCKER
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5439984
Policy instance 3
Insurance contract or identification number5439984
Number of Individuals Covered110
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $8,298
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $55,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,298
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5299478
Policy instance 2
Insurance contract or identification number5299478
Number of Individuals Covered245
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $15,117
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $151,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,117
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number742210
Policy instance 4
Insurance contract or identification number742210
Number of Individuals Covered237
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $31,590
Total amount of fees paid to insurance companyUSD $5,160
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,148,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,590
Amount paid for insurance broker fees5160
Additional information about fees paid to insurance brokerBONUS AMOUNT
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454555
Policy instance 5
Insurance contract or identification number5454555
Number of Individuals Covered166
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $5,639
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,639
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454555
Policy instance 1
Insurance contract or identification number5454555
Number of Individuals Covered159
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $4,929
Total amount of fees paid to insurance companyUSD $1,483
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,929
Amount paid for insurance broker fees1483
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM PAYMENT
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5299478
Policy instance 5
Insurance contract or identification number5299478
Number of Individuals Covered240
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $14,286
Total amount of fees paid to insurance companyUSD $4,205
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $142,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,286
Amount paid for insurance broker fees4205
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM PAYMENT
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number742210
Policy instance 4
Insurance contract or identification number742210
Number of Individuals Covered300
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $39,256
Total amount of fees paid to insurance companyUSD $5,040
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,308,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,256
Amount paid for insurance broker fees5040
Additional information about fees paid to insurance brokerPRODUCER BONUS PAYMENT PROGRAM
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5439984
Policy instance 3
Insurance contract or identification number5439984
Number of Individuals Covered88
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $6,574
Total amount of fees paid to insurance companyUSD $1,333
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $43,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,574
Amount paid for insurance broker fees1333
Additional information about fees paid to insurance brokerPRODUCER BONUS PAYMENT PROGRAM
Insurance broker organization code?3
Insurance broker nameJARBOE SHANNON GROUP LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7964802
Policy instance 2
Insurance contract or identification numberE7964802
Number of Individuals Covered67
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $5,166
Total amount of fees paid to insurance companyUSD $1,361
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,796
Amount paid for insurance broker fees982
Additional information about fees paid to insurance brokerBONUSES AND NON CASH INCENTIVES
Insurance broker organization code?3
Insurance broker nameFINCH INSURANCE GROUP LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number742210
Policy instance 1
Insurance contract or identification number742210
Number of Individuals Covered303
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $44,366
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,026,057
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 number5299478
Policy instance 1
Insurance contract or identification number5299478
Number of Individuals Covered207
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $7,578
Total amount of fees paid to insurance companyUSD $1,475
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $94,491
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 number5299478
Policy instance 1
Insurance contract or identification number5299478
Number of Individuals Covered101
Insurance policy start date2008-05-01
Insurance policy end date2009-06-30
Total amount of commissions paid to insurance brokerUSD $1,011
Total amount of fees paid to insurance companyUSD $956
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $10,113
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 number5299478
Policy instance 1
Insurance contract or identification number5299478
Number of Individuals Covered117
Insurance policy start date2007-06-01
Insurance policy end date2008-04-30
Total amount of commissions paid to insurance brokerUSD $4,472
Total amount of fees paid to insurance companyUSD $802
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $59,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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