BANNER & WITCOFF, LTD. has sponsored the creation of one or more 401k plans.
Additional information about BANNER & WITCOFF, LTD.
Submission information for form 5500 for 401k plan BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN
401k plan membership statisitcs for BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN
Measure | Date | Value |
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2022: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-04-01 | 249 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 250 |
Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
Total of all active and inactive participants | 2022-04-01 | 250 |
2021: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-04-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 247 |
Number of retired or separated participants receiving benefits | 2021-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
Total of all active and inactive participants | 2021-04-01 | 249 |
2020: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-04-01 | 283 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 298 |
Number of retired or separated participants receiving benefits | 2020-04-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 302 |
2019: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-04-01 | 265 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 279 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
Total of all active and inactive participants | 2019-04-01 | 283 |
2018: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-04-01 | 249 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 262 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 3 |
Total of all active and inactive participants | 2018-04-01 | 265 |
2017: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-04-01 | 205 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 247 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
Total of all active and inactive participants | 2017-04-01 | 249 |
2016: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-04-01 | 234 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 203 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 205 |
2015: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-04-01 | 232 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 234 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
Total of all active and inactive participants | 2015-04-01 | 234 |
2014: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-04-01 | 196 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 232 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 232 |
2013: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-04-01 | 185 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 194 |
Number of retired or separated participants receiving benefits | 2013-04-01 | 2 |
Total of all active and inactive participants | 2013-04-01 | 196 |
2012: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-04-01 | 202 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 182 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 3 |
Total of all active and inactive participants | 2012-04-01 | 185 |
2011: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-04-01 | 200 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 202 |
Total of all active and inactive participants | 2011-04-01 | 202 |
Total participants | 2011-04-01 | 202 |
2009: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-04-01 | 216 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 199 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 3 |
Total of all active and inactive participants | 2009-04-01 | 202 |
Total participants | 2009-04-01 | 202 |
2022: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2022 form 5500 responses |
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2022-04-01 | Type of plan entity | Single employer plan |
2022-04-01 | Submission has been amended | No |
2022-04-01 | This submission is the final filing | No |
2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-04-01 | Plan is a collectively bargained plan | No |
2022-04-01 | Plan funding arrangement – Insurance | Yes |
2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-04-01 | Plan benefit arrangement – Insurance | Yes |
2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2021 form 5500 responses |
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2021-04-01 | Type of plan entity | Single employer plan |
2021-04-01 | Submission has been amended | No |
2021-04-01 | This submission is the final filing | No |
2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-04-01 | Plan is a collectively bargained plan | No |
2021-04-01 | Plan funding arrangement – Insurance | Yes |
2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-04-01 | Plan benefit arrangement – Insurance | Yes |
2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2020 form 5500 responses |
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2020-04-01 | Type of plan entity | Single employer plan |
2020-04-01 | Submission has been amended | No |
2020-04-01 | This submission is the final filing | No |
2020-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-04-01 | Plan is a collectively bargained plan | No |
2020-04-01 | Plan funding arrangement – Insurance | Yes |
2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-04-01 | Plan benefit arrangement – Insurance | Yes |
2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2019 form 5500 responses |
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2019-04-01 | Type of plan entity | Single employer plan |
2019-04-01 | Submission has been amended | No |
2019-04-01 | This submission is the final filing | No |
2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-04-01 | Plan is a collectively bargained plan | No |
2019-04-01 | Plan funding arrangement – Insurance | Yes |
2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-04-01 | Plan benefit arrangement – Insurance | Yes |
2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2018 form 5500 responses |
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2018-04-01 | Type of plan entity | Single employer plan |
2018-04-01 | Plan funding arrangement – Insurance | Yes |
2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-04-01 | Plan benefit arrangement – Insurance | Yes |
2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2017 form 5500 responses |
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2017-04-01 | Type of plan entity | Single employer plan |
2017-04-01 | Plan funding arrangement – Insurance | Yes |
2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-04-01 | Plan benefit arrangement – Insurance | Yes |
2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2016 form 5500 responses |
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2016-04-01 | Type of plan entity | Single employer plan |
2016-04-01 | Plan funding arrangement – Insurance | Yes |
2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-04-01 | Plan benefit arrangement – Insurance | Yes |
2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2015 form 5500 responses |
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2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Plan funding arrangement – Insurance | Yes |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2014 form 5500 responses |
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2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Plan funding arrangement – Insurance | Yes |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2013 form 5500 responses |
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2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Plan funding arrangement – Insurance | Yes |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2012 form 5500 responses |
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2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2011 form 5500 responses |
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2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: BANNER & WITCOFF, LTD. EMPLOYEE HEALTH CARE PLAN 2009 form 5500 responses |
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2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 250 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $10,422 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $77,203 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,422 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10110321001 |
Policy instance | 4 |
Insurance contract or identification number | 10110321001 | Number of Individuals Covered | 290 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $3,053 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $26,151 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,053 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 90 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $6,348 | Total amount of fees paid to insurance company | USD $3,809 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $63,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,348 | Amount paid for insurance broker fees | 3809 | Additional information about fees paid to insurance broker | ADMINISTRATIVE & OTHER FEES | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 260 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $10,379 | Total amount of fees paid to insurance company | USD $17,437 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $299,979 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,379 | Amount paid for insurance broker fees | 17437 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 377 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $10,397 | Total amount of fees paid to insurance company | USD $11,437 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $207,949 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,397 | Amount paid for insurance broker fees | 11437 | Additional information about fees paid to insurance broker | TPA ADMIN FEES | Insurance broker organization code? | 5 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL33221 |
Policy instance | 6 |
Insurance contract or identification number | HCL33221 | Number of Individuals Covered | 221 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $97,531 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $571,514 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $97,531 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 87 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $5,866 | Total amount of fees paid to insurance company | USD $12,906 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $58,665 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,866 | Amount paid for insurance broker fees | 12906 | Additional information about fees paid to insurance broker | ADMINISTRATIVE & OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 376 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $9,228 | Total amount of fees paid to insurance company | USD $10,151 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $184,562 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,228 | Amount paid for insurance broker fees | 10151 | Additional information about fees paid to insurance broker | TPA ADMIN FEES | Insurance broker organization code? | 5 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10110321001 |
Policy instance | 4 |
Insurance contract or identification number | 10110321001 | Number of Individuals Covered | 283 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $3,928 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $30,605 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,928 | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL33221 |
Policy instance | 6 |
Insurance contract or identification number | HCL33221 | Number of Individuals Covered | 213 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $79,352 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $457,756 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $79,352 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 247 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $10,586 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $78,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,586 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 245 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $9,530 | Total amount of fees paid to insurance company | USD $14,337 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $310,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,530 | Amount paid for insurance broker fees | 14337 | Additional information about fees paid to insurance broker | FEES PAID | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG003459 |
Policy instance | 4 |
Insurance contract or identification number | VG003459 | Number of Individuals Covered | 92 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $5,756 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY GROUP LIFE | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $57,564 | Commission paid to Insurance Broker | USD $5,756 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 021360 |
Policy instance | 5 |
Insurance contract or identification number | 021360 | Number of Individuals Covered | 253 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $10,151 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $328,623 | Commission paid to Insurance Broker | USD $10,151 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5469197 |
Policy instance | 2 |
Insurance contract or identification number | 5469197 | Number of Individuals Covered | 226 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $10,822 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $216,444 | Commission paid to Insurance Broker | USD $10,822 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL027269 |
Policy instance | 3 |
Insurance contract or identification number | GL027269 | Number of Individuals Covered | 298 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $6,051 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $80,692 | Commission paid to Insurance Broker | USD $6,051 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10110321001 |
Policy instance | 1 |
Insurance contract or identification number | 10110321001 | Number of Individuals Covered | 131 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $3,735 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $26,499 | Commission paid to Insurance Broker | USD $3,735 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 83 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $5,567 | Total amount of fees paid to insurance company | USD $3,340 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $55,669 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,567 | Amount paid for insurance broker fees | 3340 | Additional information about fees paid to insurance broker | ADMINISTRATIVE | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10110321001 |
Policy instance | 4 |
Insurance contract or identification number | 10110321001 | Number of Individuals Covered | 298 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $4,000 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $27,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,000 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 265 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $10,891 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $80,676 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,891 | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL33221 |
Policy instance | 6 |
Insurance contract or identification number | HCL33221 | Number of Individuals Covered | 236 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $88,728 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $515,800 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $88,728 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 379 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $8,775 | Total amount of fees paid to insurance company | USD $9,691 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $175,503 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,775 | Amount paid for insurance broker fees | 9691 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES AND ADDITIONAL COMPENSATION | Insurance broker organization code? | 5 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 279 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $9,623 | Total amount of fees paid to insurance company | USD $15,071 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $267,336 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,623 | Amount paid for insurance broker fees | 15071 | Additional information about fees paid to insurance broker | FEES PAID AND ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 247 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $10,418 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $77,168 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,418 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10110321001 |
Policy instance | 4 |
Insurance contract or identification number | 10110321001 | Number of Individuals Covered | 104 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $2,338 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,983 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,192 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 180 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $7,844 | Total amount of fees paid to insurance company | USD $8,641 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $156,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,844 | Amount paid for insurance broker fees | 8641 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP, |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 265 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $5,790 | Total amount of fees paid to insurance company | USD $10,290 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,790 | Amount paid for insurance broker fees | 10290 | Additional information about fees paid to insurance broker | FEES PAID AND ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 73 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $4,555 | Total amount of fees paid to insurance company | USD $2,733 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,553 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,555 | Amount paid for insurance broker fees | 2733 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 226 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $8,566 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $63,452 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,566 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 4 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 81 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $3,192 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,802 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,192 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 62 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $4,301 | Total amount of fees paid to insurance company | USD $2,580 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,006 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,301 | Amount paid for insurance broker fees | 2580 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 234 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $5,472 | Total amount of fees paid to insurance company | USD $8,464 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $147,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,472 | Amount paid for insurance broker fees | 8464 | Additional information about fees paid to insurance broker | FEES PAID AND ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 153 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $6,378 | Total amount of fees paid to insurance company | USD $7,016 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $127,568 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,378 | Amount paid for insurance broker fees | 7016 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP, |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 160 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $6,369 | Total amount of fees paid to insurance company | USD $7,006 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $127,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,369 | Amount paid for insurance broker fees | 7006 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP, |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 232 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $5,555 | Total amount of fees paid to insurance company | USD $8,943 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,555 | Amount paid for insurance broker fees | 8943 | Additional information about fees paid to insurance broker | FEES PAID AND ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 71 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $4,265 | Total amount of fees paid to insurance company | USD $2,559 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,265 | Amount paid for insurance broker fees | 2559 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 4 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 86 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $3,310 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,310 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 222 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $8,835 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $65,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,835 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 146 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $5,882 | Total amount of fees paid to insurance company | USD $6,470 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,641 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,882 | Amount paid for insurance broker fees | 6470 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 66 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $4,405 | Total amount of fees paid to insurance company | USD $2,643 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,050 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,405 | Amount paid for insurance broker fees | 2643 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEE | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 208 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $9,072 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $67,203 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,072 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 4 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 76 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $2,832 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,903 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,832 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 208 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $5,481 | Total amount of fees paid to insurance company | USD $15,881 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $136,022 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,481 | Amount paid for insurance broker fees | 15881 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION & ADMINISTRATIVE FEE | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 2 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 208 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $5,483 | Total amount of fees paid to insurance company | USD $1,296 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $148,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,483 | Amount paid for insurance broker fees | 1296 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 4 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 117 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $2,659 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,996 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,659 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 5 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 208 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $8,153 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $60,396 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,153 | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 3 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 66 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $3,442 | Total amount of fees paid to insurance company | USD $2,065 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,422 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,442 | Amount paid for insurance broker fees | 2065 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEE | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 1 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 139 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $5,936 | Total amount of fees paid to insurance company | USD $7,336 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $133,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,936 | Amount paid for insurance broker fees | 7336 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 | Insurance broker name | KELLY & ASSOCIATES INSURANCE GROUP |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 1 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 215 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-21 | Total amount of commissions paid to insurance broker | USD $5,472 | Total amount of fees paid to insurance company | USD $1,104 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $147,467 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 4 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 60 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $2,938 | Total amount of fees paid to insurance company | USD $1,763 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,379 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 5 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 146 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $3,131 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,479 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 3 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 215 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-21 | Total amount of commissions paid to insurance broker | USD $8,429 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $62,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 2 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 235 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $3,439 | Total amount of fees paid to insurance company | USD $5,296 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $99,105 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 21360 |
Policy instance | 1 |
Insurance contract or identification number | 21360 | Number of Individuals Covered | 216 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $5,438 | Total amount of fees paid to insurance company | USD $1,079 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 30790-1168 |
Policy instance | 5 |
Insurance contract or identification number | 30790-1168 | Number of Individuals Covered | 82 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $3,131 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,479 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 003459 |
Policy instance | 4 |
Insurance contract or identification number | VG 003459 | Number of Individuals Covered | 59 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $2,803 | Total amount of fees paid to insurance company | USD $1,682 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,025 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TS05469197 |
Policy instance | 2 |
Insurance contract or identification number | TS05469197 | Number of Individuals Covered | 152 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $4,734 | Total amount of fees paid to insurance company | USD $7,901 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $134,812 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 027269 |
Policy instance | 3 |
Insurance contract or identification number | GL 027269 | Number of Individuals Covered | 216 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $8,367 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $61,981 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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