401k Plan data: NAPLETON DEALERSHIP GROUP plan

NAPLETON DEALERSHIP GROUP 401k Plan overview

Plan Name	NAPLETON DEALERSHIP GROUP
Plan identification number	501

NAPLETON DEALERSHIP GROUP Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

NORTH AMERICAN AUTOMOTIVE SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name: NORTH AMERICAN AUTOMOTIVE SERVICES, INC

Employer identification number (EIN): 363796094

NAIC Classification: 561490

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NAPLETON DEALERSHIP GROUP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 BRUCE C. ETHERIDGE
501 2017-01-01 BRUCE C. ETHERIDGE
501 2016-01-01 BRUCE C. ETHERIDGE
501 2015-01-01 BRUCE C. ETHERIDGE
501 2014-01-01 BRUCE C. ETHERIDGE
501 2013-01-01 BRUCE C. ETHERIDGE BRUCE C. ETHERIDGE 2014-06-10
501 2012-01-01 BRUCE C. ETHERIDGE
501 2011-01-01 BRUCE C ETHERIDGE

Plan Statistics for NAPLETON DEALERSHIP GROUP

401k plan membership statisitcs for NAPLETON DEALERSHIP GROUP

Measure Date Value
2022: NAPLETON DEALERSHIP GROUP 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,605
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3,057
Total of all active and inactive participants 2022-01-01 3,057
Total participants 2022-01-01 3,057
2021: NAPLETON DEALERSHIP GROUP 2021 401k membership
Total participants, beginning-of-year 2021-01-01 3,104
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 3,605
Total of all active and inactive participants 2021-01-01 3,605
Total participants 2021-01-01 3,605
2020: NAPLETON DEALERSHIP GROUP 2020 401k membership
Total participants, beginning-of-year 2020-01-01 4,055
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3,104
Total of all active and inactive participants 2020-01-01 3,104
Total participants 2020-01-01 3,104
2019: NAPLETON DEALERSHIP GROUP 2019 401k membership
Total participants, beginning-of-year 2019-01-01 3,787
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 4,055
Total of all active and inactive participants 2019-01-01 4,055
Total participants 2019-01-01 4,055
2018: NAPLETON DEALERSHIP GROUP 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3,002
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 3,787
Total of all active and inactive participants 2018-01-01 3,787
Total participants 2018-01-01 3,787
2017: NAPLETON DEALERSHIP GROUP 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,350
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3,002
Total of all active and inactive participants 2017-01-01 3,002
Total participants 2017-01-01 3,002
2016: NAPLETON DEALERSHIP GROUP 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,621
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,616
Total of all active and inactive participants 2016-01-01 1,616
Total participants 2016-01-01 1,616
2015: NAPLETON DEALERSHIP GROUP 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,141
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,621
Total of all active and inactive participants 2015-01-01 1,621
Total participants 2015-01-01 0
2014: NAPLETON DEALERSHIP GROUP 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,212
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,141
Total of all active and inactive participants 2014-01-01 1,141
Total participants 2014-01-01 0
2013: NAPLETON DEALERSHIP GROUP 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,075
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,212
Total of all active and inactive participants 2013-01-01 1,212
Total participants 2013-01-01 0
2012: NAPLETON DEALERSHIP GROUP 2012 401k membership
Total participants, beginning-of-year 2012-01-01 983
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,075
Total of all active and inactive participants 2012-01-01 1,075
Total participants 2012-01-01 1,075
2011: NAPLETON DEALERSHIP GROUP 2011 401k membership
Total participants, beginning-of-year 2011-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 983
Total of all active and inactive participants 2011-01-01 983
Total participants 2011-01-01 983

Measure	Date	Value
2022: NAPLETON DEALERSHIP GROUP 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,605
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,057
Total of all active and inactive participants	2022-01-01	3,057
Total participants	2022-01-01	3,057
2021: NAPLETON DEALERSHIP GROUP 2021 401k membership
Total participants, beginning-of-year	2021-01-01	3,104
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3,605
Total of all active and inactive participants	2021-01-01	3,605
Total participants	2021-01-01	3,605
2020: NAPLETON DEALERSHIP GROUP 2020 401k membership
Total participants, beginning-of-year	2020-01-01	4,055
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3,104
Total of all active and inactive participants	2020-01-01	3,104
Total participants	2020-01-01	3,104
2019: NAPLETON DEALERSHIP GROUP 2019 401k membership
Total participants, beginning-of-year	2019-01-01	3,787
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	4,055
Total of all active and inactive participants	2019-01-01	4,055
Total participants	2019-01-01	4,055
2018: NAPLETON DEALERSHIP GROUP 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,002
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3,787
Total of all active and inactive participants	2018-01-01	3,787
Total participants	2018-01-01	3,787
2017: NAPLETON DEALERSHIP GROUP 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,350
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,002
Total of all active and inactive participants	2017-01-01	3,002
Total participants	2017-01-01	3,002
2016: NAPLETON DEALERSHIP GROUP 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,621
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,616
Total of all active and inactive participants	2016-01-01	1,616
Total participants	2016-01-01	1,616
2015: NAPLETON DEALERSHIP GROUP 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,141
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,621
Total of all active and inactive participants	2015-01-01	1,621
Total participants	2015-01-01	0
2014: NAPLETON DEALERSHIP GROUP 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,212
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,141
Total of all active and inactive participants	2014-01-01	1,141
Total participants	2014-01-01	0
2013: NAPLETON DEALERSHIP GROUP 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,075
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,212
Total of all active and inactive participants	2013-01-01	1,212
Total participants	2013-01-01	0
2012: NAPLETON DEALERSHIP GROUP 2012 401k membership
Total participants, beginning-of-year	2012-01-01	983
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,075
Total of all active and inactive participants	2012-01-01	1,075
Total participants	2012-01-01	1,075
2011: NAPLETON DEALERSHIP GROUP 2011 401k membership
Total participants, beginning-of-year	2011-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	983
Total of all active and inactive participants	2011-01-01	983
Total participants	2011-01-01	983

Financial Data on NAPLETON DEALERSHIP GROUP

Measure	Date	Value
2013 : NAPLETON DEALERSHIP GROUP 2013 401k financial data
Total income from all sources	2013-12-31	$3,779,403
Expenses. Total of all expenses incurred	2013-12-31	$3,779,403
Benefits paid (including direct rollovers)	2013-12-31	$3,779,403
Total contributions received or receivable from participants	2013-12-31	$2,078,672
Total contributions received or receivable from employer(s)	2013-12-31	$1,700,731
2012 : NAPLETON DEALERSHIP GROUP 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$3,861,933
Expenses. Total of all expenses incurred	2012-12-31	$3,861,933
Benefits paid (including direct rollovers)	2012-12-31	$3,861,933
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$2,124,063
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$1,737,870
2011 : NAPLETON DEALERSHIP GROUP 2011 401k financial data
Total income from all sources	2011-12-31	$3,384,794
Expenses. Total of all expenses incurred	2011-12-31	$3,384,794
Benefits paid (including direct rollovers)	2011-12-31	$3,384,794
Total contributions received or receivable from participants	2011-12-31	$1,861,637
Total contributions received or receivable from employer(s)	2011-12-31	$1,523,157

Form 5500 Responses for NAPLETON DEALERSHIP GROUP

2022: NAPLETON DEALERSHIP GROUP 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: NAPLETON DEALERSHIP GROUP 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: NAPLETON DEALERSHIP GROUP 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: NAPLETON DEALERSHIP GROUP 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: NAPLETON DEALERSHIP GROUP 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: NAPLETON DEALERSHIP GROUP 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: NAPLETON DEALERSHIP GROUP 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: NAPLETON DEALERSHIP GROUP 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: NAPLETON DEALERSHIP GROUP 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: NAPLETON DEALERSHIP GROUP 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: NAPLETON DEALERSHIP GROUP 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: NAPLETON DEALERSHIP GROUP 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $12,900
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12900
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $42,097
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	42097
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913381

Policy instance

Insurance contract or identification number	913381
Insurance policy start date	2022-01-01
Insurance policy end date	2022-08-31
Total amount of fees paid to insurance company	USD $179,789
Other welfare benefits provided	ACCIDENT INSURANCE & VOLSTD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	179789
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

73063-7

Policy instance

Insurance contract or identification number	73063-7
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $188,014
Other welfare benefits provided	ACCIDENT & STD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	180562
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $10,440
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	10440
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

142963

Policy instance

Insurance contract or identification number	142963
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703194

Policy instance

Insurance contract or identification number	703194
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of fees paid to insurance company	USD $1,518
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1518
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

417004411822

Policy instance

Insurance contract or identification number	417004411822
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72282-1

Policy instance

Insurance contract or identification number	72282-1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $6,662
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT INSURANCE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6662
Additional information about fees paid to insurance broker	TECHNOLOGY FEE
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

427647

Policy instance

Insurance contract or identification number	427647
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of fees paid to insurance company	USD $90
Other welfare benefits provided	STD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	90
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72312-6

Policy instance

Insurance contract or identification number	72312-6
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $131,747
Other welfare benefits provided	EXCESS RISK
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	82342
Additional information about fees paid to insurance broker	SERVICE FEE

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-22

Policy instance

Insurance contract or identification number	4EL-4053-22
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

TRADITIONAL LIF

Policy instance

Insurance contract or identification number	TRADITIONAL LIF
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $330,418
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	330418
Additional information about fees paid to insurance broker	COMMISSIONS PAID

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	45
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913381

Policy instance

Insurance contract or identification number	913381
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	ACCIDENT INSURANCE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	1814
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72282-1

Policy instance

Insurance contract or identification number	72282-1
Number of Individuals Covered	2709
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703195

Policy instance

Insurance contract or identification number	703195
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913650

Policy instance

Insurance contract or identification number	913650
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-19

Policy instance

Insurance contract or identification number	4EL-4053-19
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	ACCESS FEES

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

417004411822

Policy instance

Insurance contract or identification number	417004411822
Number of Individuals Covered	2500
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

417003411822

Policy instance

Insurance contract or identification number	417003411822
Insurance policy start date	2019-09-01
Insurance policy end date	2020-09-01
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703194

Policy instance

Insurance contract or identification number	703194
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-20

Policy instance

Insurance contract or identification number	4EL-4053-20
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

142963

Policy instance

Insurance contract or identification number	142963
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913381

Policy instance

Insurance contract or identification number	913381
Number of Individuals Covered	1147
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $245,717
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $541,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $245,717
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	45
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $12,490
Total amount of fees paid to insurance company	USD $32
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $209,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,490
Amount paid for insurance broker fees	32
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	47
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $10,874
Total amount of fees paid to insurance company	USD $32
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $222,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,874
Amount paid for insurance broker fees	32
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913650

Policy instance

Insurance contract or identification number	913650
Number of Individuals Covered	1605
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,762,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-19

Policy instance

Insurance contract or identification number	4EL-4053-19
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $1,618
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $809
Additional information about fees paid to insurance broker	ACCESS FEES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703195

Policy instance

Insurance contract or identification number	703195
Number of Individuals Covered	2471
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $6,682
Total amount of fees paid to insurance company	USD $2,185
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $377,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,176
Insurance broker organization code?	3
Amount paid for insurance broker fees	2185

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

142963

Policy instance

Insurance contract or identification number	142963
Number of Individuals Covered	36
Insurance policy start date	2020-10-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-20

Policy instance

Insurance contract or identification number	4EL-4053-20
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703194

Policy instance

Insurance contract or identification number	703194
Number of Individuals Covered	492
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $124,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

427647

Policy instance

Insurance contract or identification number	427647
Number of Individuals Covered	49
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $14,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

417003411822

Policy instance

Insurance contract or identification number	417003411822
Number of Individuals Covered	1338
Insurance policy start date	2019-09-01
Insurance policy end date	2020-09-01
Welfare Benefit Premiums Paid to Carrier	USD $1,536,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	1710
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,999
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $851,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,999
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0012631591

Policy instance

Insurance contract or identification number	0012631591
Number of Individuals Covered	667
Insurance policy start date	2020-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $181,273
Total amount of fees paid to insurance company	USD $18,186
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $181,273
Insurance broker organization code?	3
Amount paid for insurance broker fees	18186

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913381

Policy instance

Insurance contract or identification number	913381
Number of Individuals Covered	1014
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $315,293
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $392,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $217,653
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	1555
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $48,458
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $814,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,459
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-19

Policy instance

Insurance contract or identification number	4EL-4053-19
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $809
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $809
Additional information about fees paid to insurance broker	ACCESS FEES

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	39
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,496
Total amount of fees paid to insurance company	USD $18
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $491,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,496
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	35
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,384
Total amount of fees paid to insurance company	USD $32
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,384
Amount paid for insurance broker fees	32
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

913650

Policy instance

Insurance contract or identification number	913650
Number of Individuals Covered	1362
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,019,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-4053-18

Policy instance

Insurance contract or identification number	4EL-4053-18
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $809
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $809
Additional information about fees paid to insurance broker	ACCESS FEES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703194

Policy instance

Insurance contract or identification number	703194
Number of Individuals Covered	2310
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $53,754
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $376,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,754

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

142963

Policy instance

Insurance contract or identification number	142963
Number of Individuals Covered	33
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

914

Policy instance

Insurance contract or identification number	914
Number of Individuals Covered	163
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $1,771
Welfare Benefit Premiums Paid to Carrier	USD $177,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,771
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker organization code?	5

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

914

Policy instance

Insurance contract or identification number	914
Number of Individuals Covered	166
Insurance policy start date	2018-09-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $903
Welfare Benefit Premiums Paid to Carrier	USD $90,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $903
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker organization code?	5

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

17-040

Policy instance

Insurance contract or identification number	17-040
Insurance policy start date	2018-01-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $24,342
Other welfare benefits provided	AGGREGATE
Welfare Benefit Premiums Paid to Carrier	USD $162,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,719
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	1219
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $67,358
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $727,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,358
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5584222/5931764

Policy instance

Insurance contract or identification number	5584222/5931764
Number of Individuals Covered	1989
Insurance policy start date	2018-01-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $33,914
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $196,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,914
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	27
Insurance policy start date	2018-09-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,818
Total amount of fees paid to insurance company	USD $18
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,818
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

10118132

Policy instance

Insurance contract or identification number	10118132
Number of Individuals Covered	36
Insurance policy start date	2018-09-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,322
Total amount of fees paid to insurance company	USD $18
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,322
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	BROKER FEE
Insurance broker organization code?	3

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

417002411822

Policy instance

Insurance contract or identification number	417002411822
Insurance policy start date	2018-01-01
Insurance policy end date	2018-08-31
Welfare Benefit Premiums Paid to Carrier	USD $510,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

417003411822

Policy instance

Insurance contract or identification number	417003411822
Number of Individuals Covered	914
Insurance policy start date	2018-09-01
Insurance policy end date	2018-12-31
Welfare Benefit Premiums Paid to Carrier	USD $262,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-8088-17

Policy instance

Insurance contract or identification number	4EL-8088-17
Number of Individuals Covered	4
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $2,462
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,462
Additional information about fees paid to insurance broker	ACCESS FEE

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

703194

Policy instance

Insurance contract or identification number	703194
Number of Individuals Covered	2156
Insurance policy start date	2018-09-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,928
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,928

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

16-020/17-039

Policy instance

Insurance contract or identification number	16-020/17-039
Number of Individuals Covered	930
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Welfare Benefit Premiums Paid to Carrier	USD $508,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5584222/KMX1764

Policy instance

Insurance contract or identification number	5584222/KMX1764
Number of Individuals Covered	1957
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $41,010
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $256,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,010
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	1131
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57,846
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $624,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,846
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

16-022/17-040

Policy instance

Insurance contract or identification number	16-022/17-040
Number of Individuals Covered	115
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,936
Welfare Benefit Premiums Paid to Carrier	USD $192,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,007
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3
Insurance broker name	BENEFIT ADMINISTRATIVE SYSTEMS, LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5584222

Policy instance

Insurance contract or identification number	5584222
Number of Individuals Covered	1621
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $23,004
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $175,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,004
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	744
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $34,038
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $482,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,038
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05584222

Policy instance

Insurance contract or identification number	KM05584222
Number of Individuals Covered	1141
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $22,000
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $123,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,000
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717871

Policy instance

Insurance contract or identification number	0717871
Number of Individuals Covered	372
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $94,541
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,137,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	94541
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	595
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,924
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $395,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,924
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717871

Policy instance

Insurance contract or identification number	0717871
Number of Individuals Covered	502
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $166,592
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,265,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	166592
Additional information about fees paid to insurance broker	CONSULTATION ON MEDICAL PLAN MATTERS
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05584222

Policy instance

Insurance contract or identification number	KM05584222
Number of Individuals Covered	1212
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $21,757
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $122,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,757
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER & ASSOCIATES, LTD

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	578
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $16,748
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $391,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,748
Insurance broker organization code?	3
Insurance broker name	JOSEPH T SNYDER

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	521
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $15,335
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $373
Insurance broker organization code?	0
Insurance broker name	MARK C PIETSCH

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

717871

Policy instance

Insurance contract or identification number	717871
Number of Individuals Covered	372
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $145,848
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,392,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $145,848
Insurance broker name	JOSEPH T SNYDER & ASSOC LTD

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05584222

Policy instance

Insurance contract or identification number	KM05584222
Number of Individuals Covered	1075
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $20,946
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $119,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,946
Insurance broker organization code?	0
Insurance broker name	SNYDER JOSEPH T & ASSOCIATES LTD

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05584222

Policy instance

Insurance contract or identification number	KM05584222
Number of Individuals Covered	982
Total amount of commissions paid to insurance broker	USD $18,551
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717871

Policy instance

Insurance contract or identification number	0717871
Number of Individuals Covered	372
Total amount of commissions paid to insurance broker	USD $43,843
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00380854

Policy instance

Insurance contract or identification number	00380854
Number of Individuals Covered	473
Total amount of commissions paid to insurance broker	USD $12,928
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B92550

Policy instance

Insurance contract or identification number	B92550
Number of Individuals Covered	416
Total amount of commissions paid to insurance broker	USD $88,198
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTH AMERICAN AUTOMOTIVE SERVICES, INC
Employer identification number (EIN):	363796094
NAIC Classification:	561490