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BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 401k Plan overview

Plan NameBRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT
Plan identification number 501

BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BRADFORD COMPANY has sponsored the creation of one or more 401k plans.

Company Name:BRADFORD COMPANY
Employer identification number (EIN):381903019
NAIC Classification:322200

Additional information about BRADFORD COMPANY

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 071163
Legal Registered Office Address: QUINCY ST. HOLLAND 49424


United States of America (USA)
13500

More information about BRADFORD COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-03-01DOUGLAS BRINK2023-10-16
5012021-03-01
5012020-03-01
5012019-03-01
5012018-03-01
5012017-03-01DOUGLAS BRINK
5012016-03-01DOUGLAS BRINK
5012015-03-01DOUGLAS BRINK
5012014-03-01DOUGLAS BRINK
5012013-03-01DOUGLAS BRINK
5012012-03-01DOUGLAS BRINK
5012011-03-01DOUGLAS BRINK
5012009-03-01DOUGLAS BRINK

Plan Statistics for BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT

401k plan membership statisitcs for BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT

Measure Date Value
2022: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2022 401k membership
Total participants, beginning-of-year2022-03-01291
Total number of active participants reported on line 7a of the Form 55002022-03-01304
Total of all active and inactive participants2022-03-01304
2021: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year2021-03-01272
Total number of active participants reported on line 7a of the Form 55002021-03-01291
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-01291
2020: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year2020-03-01300
Total number of active participants reported on line 7a of the Form 55002020-03-01272
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01272
2019: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year2019-03-01269
Total number of active participants reported on line 7a of the Form 55002019-03-01300
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01300
2018: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year2018-03-01261
Total number of active participants reported on line 7a of the Form 55002018-03-01269
Number of retired or separated participants receiving benefits2018-03-010
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-01269
2017: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year2017-03-01247
Total number of active participants reported on line 7a of the Form 55002017-03-01261
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01261
2016: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year2016-03-01236
Total number of active participants reported on line 7a of the Form 55002016-03-01247
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-01247
2015: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year2015-03-01225
Total number of active participants reported on line 7a of the Form 55002015-03-01236
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01236
2014: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year2014-03-01214
Total number of active participants reported on line 7a of the Form 55002014-03-01225
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01225
2013: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year2013-03-01217
Total number of active participants reported on line 7a of the Form 55002013-03-01214
Total of all active and inactive participants2013-03-01214
2012: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year2012-03-01167
Total number of active participants reported on line 7a of the Form 55002012-03-01217
Total of all active and inactive participants2012-03-01217
2011: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year2011-03-01149
Total number of active participants reported on line 7a of the Form 55002011-03-01167
Total of all active and inactive participants2011-03-01167
2009: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year2009-03-01178
Total number of active participants reported on line 7a of the Form 55002009-03-01154
Total of all active and inactive participants2009-03-01154

Form 5500 Responses for BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT

2022: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – InsuranceYes
2021: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – InsuranceYes
2020: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – InsuranceYes
2019: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2009: BRADFORD COMPANY GROUP LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered304
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $651
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $651
Additional information about fees paid to insurance brokerSTANDARD COMMISSIONS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered304
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $8,412
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,412
Additional information about fees paid to insurance brokerSTANDARD COMMISSIONS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered291
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $2,420
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,420
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered291
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $1,182
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,182
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered272
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $8,090
Total amount of fees paid to insurance companyUSD $1,838
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,090
Amount paid for insurance broker fees1838
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered272
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $609
Total amount of fees paid to insurance companyUSD $138
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $609
Amount paid for insurance broker fees138
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered300
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $373
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $3,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $373
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered300
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $5,643
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,643
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered269
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $440
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $4,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $440
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered269
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $6,822
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,822
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 1
Insurance contract or identification numberSGM606715
Number of Individuals Covered261
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $6,965
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,965
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker nameADVANTAGE BENEFITS GROUP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 2
Insurance contract or identification numberSOK604755
Number of Individuals Covered261
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $433
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $4,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $433
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker nameADVANTAGE BENEFITS GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148887
Policy instance 1
Insurance contract or identification number148887
Number of Individuals Covered72
Insurance policy start date2014-07-01
Insurance policy end date2015-07-01
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604755
Policy instance 4
Insurance contract or identification numberSOK604755
Number of Individuals Covered236
Insurance policy start date2015-07-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $164
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $164
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker nameADVANTAGE BENEFITS GROUP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM606715
Policy instance 3
Insurance contract or identification numberSGM606715
Number of Individuals Covered72
Insurance policy start date2015-07-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $2,561
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,561
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker nameADVANTAGE BENEFITS GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148888
Policy instance 2
Insurance contract or identification number148888
Number of Individuals Covered230
Insurance policy start date2014-07-01
Insurance policy end date2015-07-01
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $59,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148888
Policy instance 2
Insurance contract or identification number148888
Number of Individuals Covered225
Insurance policy start date2013-07-01
Insurance policy end date2014-07-01
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $59,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148887
Policy instance 1
Insurance contract or identification number148887
Number of Individuals Covered74
Insurance policy start date2013-07-01
Insurance policy end date2014-07-01
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148887
Policy instance 1
Insurance contract or identification number148887
Number of Individuals Covered73
Insurance policy start date2012-07-01
Insurance policy end date2013-07-01
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148888
Policy instance 2
Insurance contract or identification number148888
Number of Individuals Covered214
Insurance policy start date2012-07-01
Insurance policy end date2013-07-01
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $42,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148887
Policy instance 1
Insurance contract or identification number148887
Number of Individuals Covered72
Insurance policy start date2011-07-01
Insurance policy end date2012-07-01
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148888
Policy instance 2
Insurance contract or identification number148888
Number of Individuals Covered217
Insurance policy start date2011-07-01
Insurance policy end date2012-07-01
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $35,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148887
Policy instance 1
Insurance contract or identification number148887
Number of Individuals Covered67
Insurance policy start date2010-07-01
Insurance policy end date2011-07-01
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148888
Policy instance 2
Insurance contract or identification number148888
Number of Individuals Covered167
Insurance policy start date2010-07-01
Insurance policy end date2011-07-01
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $34,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number142932
Policy instance 1
Insurance contract or identification number142932
Number of Individuals Covered149
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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