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CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 401k Plan overview

Plan NameCARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN
Plan identification number 501

CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CARLISLE ETCETERA LLC has sponsored the creation of one or more 401k plans.

Company Name:CARLISLE ETCETERA LLC
Employer identification number (EIN):455022305
NAIC Classification:424300

Additional information about CARLISLE ETCETERA LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2012-05-10
Company Identification Number: 0801595829
Legal Registered Office Address: 246 W 38TH ST RM 503

NEW YORK
United States of America (USA)
10018

More information about CARLISLE ETCETERA LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01MELISSA EVWIEHOR2019-10-23
5012017-01-01MELISSA EVWIEHOR2019-10-23
5012016-01-01AVA TYSON-MASON
5012015-01-01AVA TYSON-MASON
5012014-01-01AVA TYSON-MASON
5012013-01-01AVA TYSON-MASON AVA TYSON-MASON2014-10-14
5012012-01-01AVA TYSON-MASON AVA TYSON-MASON2013-10-15

Plan Statistics for CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN

401k plan membership statisitcs for CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN

Measure Date Value
2022: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01164
Total number of active participants reported on line 7a of the Form 55002022-01-0172
Total of all active and inactive participants2022-01-0172
2021: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01206
Total number of active participants reported on line 7a of the Form 55002021-01-01164
Total of all active and inactive participants2021-01-01164
2020: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01189
Total number of active participants reported on line 7a of the Form 55002020-01-01206
Total of all active and inactive participants2020-01-01206
2019: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01202
Total number of active participants reported on line 7a of the Form 55002019-01-01189
Total of all active and inactive participants2019-01-01189
2018: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01241
Total number of active participants reported on line 7a of the Form 55002018-01-01202
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01202
Number of employers contributing to the scheme2018-01-010
2017: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01247
Total number of active participants reported on line 7a of the Form 55002017-01-01241
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01241
Number of employers contributing to the scheme2017-01-010
2016: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01267
Total number of active participants reported on line 7a of the Form 55002016-01-01247
Total of all active and inactive participants2016-01-01247
2015: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01331
Total number of active participants reported on line 7a of the Form 55002015-01-01267
Number of retired or separated participants receiving benefits2015-01-011
Total of all active and inactive participants2015-01-01268
2014: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01328
Total number of active participants reported on line 7a of the Form 55002014-01-01331
Total of all active and inactive participants2014-01-01331
2013: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01235
Total number of active participants reported on line 7a of the Form 55002013-01-01328
Total of all active and inactive participants2013-01-01328
2012: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01312
Total number of active participants reported on line 7a of the Form 55002012-01-01235
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01235

Form 5500 Responses for CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN

2022: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulti-employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulti-employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulti-employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulti-employer plan
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulti-employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulti-employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CARLISLE ETCETERA LLC WELFARE AND BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number403005628
Policy instance 6
Insurance contract or identification number403005628
Number of Individuals Covered25
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $98
Total amount of fees paid to insurance companyUSD $176
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Amount paid for insurance broker fees110
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number1D032399
Policy instance 5
Insurance contract or identification number1D032399
Number of Individuals Covered53
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,977
Total amount of fees paid to insurance companyUSD $2,727
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2472
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,977
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number400217072
Policy instance 4
Insurance contract or identification number400217072
Number of Individuals Covered29
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,336
Total amount of fees paid to insurance companyUSD $1,299
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,336
Amount paid for insurance broker fees188
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217073
Policy instance 3
Insurance contract or identification number10217073
Number of Individuals Covered23
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $3,983
Total amount of fees paid to insurance companyUSD $3,577
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $20,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,983
Amount paid for insurance broker fees356
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217071
Policy instance 2
Insurance contract or identification number10217071
Number of Individuals Covered65
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,657
Total amount of fees paid to insurance companyUSD $2,150
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,657
Amount paid for insurance broker fees322
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered72
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $919
Total amount of fees paid to insurance companyUSD $1,377
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $919
Amount paid for insurance broker fees235
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered86
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $1,551
Total amount of fees paid to insurance companyUSD $2,018
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $12,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,371
Insurance broker organization code?3
Amount paid for insurance broker fees1165
Additional information about fees paid to insurance brokerMEMBER SURVEYS, MATERIAL PREP., PREMIUM COLLECT, BILLING
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217071
Policy instance 2
Insurance contract or identification number10217071
Number of Individuals Covered81
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,801
Total amount of fees paid to insurance companyUSD $3,255
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,478
Insurance broker organization code?3
Amount paid for insurance broker fees1842
Additional information about fees paid to insurance brokerMEMBER SURVEYS, MATERIAL PREP., PREMIUM COLL. BILLING
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217073
Policy instance 3
Insurance contract or identification number10217073
Number of Individuals Covered32
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $5,008
Total amount of fees paid to insurance companyUSD $4,241
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $25,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,588
Insurance broker organization code?3
Amount paid for insurance broker fees2435
Additional information about fees paid to insurance brokerMEMBER SURVEYS, MATERIAL PREP., PREMIUM COLL. BILLING
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number400217072
Policy instance 4
Insurance contract or identification number400217072
Number of Individuals Covered34
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $1,640
Total amount of fees paid to insurance companyUSD $1,408
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,470
Insurance broker organization code?3
Amount paid for insurance broker fees811
Additional information about fees paid to insurance brokerMEMBER SURVEYS, MATERIAL PREP., PREMIUM COLL. BILLING
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number1D032399
Policy instance 5
Insurance contract or identification number1D032399
Number of Individuals Covered66
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $3,103
Total amount of fees paid to insurance companyUSD $4,147
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4147
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,833
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10233632
Policy instance 6
Insurance contract or identification number10233632
Number of Individuals Covered164
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,644
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedNY DISABILITY/FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $24,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,535
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number403005628
Policy instance 7
Insurance contract or identification number403005628
Number of Individuals Covered26
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $149
Total amount of fees paid to insurance companyUSD $101
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135
Insurance broker organization code?3
Amount paid for insurance broker fees56
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217071
Policy instance 2
Insurance contract or identification number10217071
Number of Individuals Covered160
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $4,031
Total amount of fees paid to insurance companyUSD $4,585
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,031
Insurance broker organization code?3
Amount paid for insurance broker fees2486
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered164
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,952
Total amount of fees paid to insurance companyUSD $2,498
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,952
Insurance broker organization code?3
Amount paid for insurance broker fees1338
Additional information about fees paid to insurance brokerOVERRIDES, BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217073
Policy instance 3
Insurance contract or identification number10217073
Number of Individuals Covered38
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $5,150
Total amount of fees paid to insurance companyUSD $4,315
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $28,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,150
Insurance broker organization code?3
Amount paid for insurance broker fees2353
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number400217072
Policy instance 4
Insurance contract or identification number400217072
Number of Individuals Covered51
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,833
Total amount of fees paid to insurance companyUSD $1,640
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,833
Insurance broker organization code?3
Amount paid for insurance broker fees910
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number1D032399
Policy instance 5
Insurance contract or identification number1D032399
Number of Individuals Covered108
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $3,027
Total amount of fees paid to insurance companyUSD $4,411
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4411
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $3,027
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10233632
Policy instance 6
Insurance contract or identification number10233632
Number of Individuals Covered206
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,015
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedNY DISABILITY/FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $8,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,015
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number403005628
Policy instance 7
Insurance contract or identification number403005628
Number of Individuals Covered38
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $151
Total amount of fees paid to insurance companyUSD $127
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $151
Insurance broker organization code?3
Amount paid for insurance broker fees82
Additional information about fees paid to insurance brokerOVERRIDES AND BROKER BONUS
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number403005628
Policy instance 7
Insurance contract or identification number403005628
Number of Individuals Covered30
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $141
Total amount of fees paid to insurance companyUSD $123
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $141
Amount paid for insurance broker fees39
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10233632
Policy instance 6
Insurance contract or identification number10233632
Number of Individuals Covered189
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $2,430
Total amount of fees paid to insurance companyUSD $202
Other welfare benefits providedNY DISABILITY/FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $20,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,430
Amount paid for insurance broker fees202
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number1D032399
Policy instance 5
Insurance contract or identification number1D032399
Number of Individuals Covered104
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $2,325
Total amount of fees paid to insurance companyUSD $3,805
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,325
Amount paid for insurance broker fees744
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number400217072
Policy instance 4
Insurance contract or identification number400217072
Number of Individuals Covered50
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,922
Total amount of fees paid to insurance companyUSD $2,094
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,922
Amount paid for insurance broker fees364
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217073
Policy instance 3
Insurance contract or identification number10217073
Number of Individuals Covered39
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $4,753
Total amount of fees paid to insurance companyUSD $4,643
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $26,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,753
Amount paid for insurance broker fees740
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217071
Policy instance 2
Insurance contract or identification number10217071
Number of Individuals Covered162
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $3,519
Total amount of fees paid to insurance companyUSD $4,786
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,519
Amount paid for insurance broker fees761
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered166
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $1,736
Total amount of fees paid to insurance companyUSD $2,609
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,736
Amount paid for insurance broker fees431
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered202
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $19,004
Total amount of fees paid to insurance companyUSD $22,006
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $166,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,004
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOVERRIDES
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number10217070
Policy instance 1
Insurance contract or identification number10217070
Number of Individuals Covered241
Insurance policy start date2016-06-01
Insurance policy end date2017-05-31
Total amount of commissions paid to insurance brokerUSD $19,745
Total amount of fees paid to insurance companyUSD $28,174
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $192,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 1
Insurance contract or identification number23028
Number of Individuals Covered288
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $4,385
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,007
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 2
Insurance contract or identification number23028
Number of Individuals Covered269
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $446
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $407
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 3
Insurance contract or identification number23028
Number of Individuals Covered158
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,988
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $13,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,833
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 4
Insurance contract or identification number23028
Number of Individuals Covered254
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $6,379
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,868
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number221092
Policy instance 6
Insurance contract or identification number221092
Number of Individuals Covered8
Insurance policy start date2015-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $4,045
Total amount of fees paid to insurance companyUSD $269
Are there contracts with allocated funds for individual policies?Yes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,982
Amount paid for insurance broker fees269
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker namePETER JONES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 5
Insurance contract or identification number23028
Number of Individuals Covered165
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,871
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Other welfare benefits providedNEW YORK DBL
Welfare Benefit Premiums Paid to CarrierUSD $12,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,716
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0847845-SL
Policy instance 7
Insurance contract or identification number0847845-SL
Number of Individuals Covered147
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker name
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 1
Insurance contract or identification number23028
Number of Individuals Covered263
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $2,166
Total amount of fees paid to insurance companyUSD $18
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,166
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees18
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 2
Insurance contract or identification number23028
Number of Individuals Covered263
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $274
Total amount of fees paid to insurance companyUSD $2
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $274
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees2
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 3
Insurance contract or identification number23028
Number of Individuals Covered169
Insurance policy start date2014-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $3,257
Total amount of fees paid to insurance companyUSD $19
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedNEW YORK DBL
Welfare Benefit Premiums Paid to CarrierUSD $21,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,257
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees19
Insurance broker nameAXA ASSISTANCE, USA
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSTOP LOSS
Policy instance 4
Insurance contract or identification numberSTOP LOSS
Number of Individuals Covered149
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $105,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 6
Insurance contract or identification number23028
Number of Individuals Covered162
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,812
Total amount of fees paid to insurance companyUSD $10
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $12,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,812
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees10
Insurance broker nameAXA ASSISTANCE, USA
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number221092
Policy instance 5
Insurance contract or identification number221092
Number of Individuals Covered10
Insurance policy start date2014-06-01
Insurance policy end date2015-06-01
Total amount of commissions paid to insurance brokerUSD $4,368
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,368
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Insurance broker nameJONES, PETER C
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 7
Insurance contract or identification number23028
Number of Individuals Covered263
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $6,254
Total amount of fees paid to insurance companyUSD $36
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,254
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees36
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 1
Insurance contract or identification number23028
Number of Individuals Covered328
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $3,493
Total amount of fees paid to insurance companyUSD $608
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,493
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerPRINTING SERVICES
Insurance broker nameHARVARD PRINTING GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 2
Insurance contract or identification number23028
Number of Individuals Covered108
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $3,493
Total amount of fees paid to insurance companyUSD $608
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $6,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,493
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerPRINTING SERVICES
Insurance broker nameHARVARD PRINTING GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number23028
Policy instance 3
Insurance contract or identification number23028
Number of Individuals Covered220
Insurance policy start date2013-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $3,493
Total amount of fees paid to insurance companyUSD $608
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedNEW YORK DBL
Welfare Benefit Premiums Paid to CarrierUSD $16,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,493
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerPRINTING SERVICES
Insurance broker nameHARVARD PRINTING GROUP
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number221092
Policy instance 4
Insurance contract or identification number221092
Number of Individuals Covered15
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $7,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number224162
Policy instance 3
Insurance contract or identification number224162
Number of Individuals Covered211
Insurance policy start date2012-02-01
Insurance policy end date2013-02-01
Total amount of commissions paid to insurance brokerUSD $1,355
Total amount of fees paid to insurance companyUSD $86
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $537
Amount paid for insurance broker fees86
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameBUCK CONSULTANTS LLC
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number224163
Policy instance 2
Insurance contract or identification number224163
Number of Individuals Covered235
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $5,523
Total amount of fees paid to insurance companyUSD $332
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $54,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,092
Amount paid for insurance broker fees332
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker namePETER C. JONES
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000064776938
Policy instance 1
Insurance contract or identification number000064776938
Number of Individuals Covered3
Insurance policy start date2011-09-25
Insurance policy end date2012-09-25
Total amount of commissions paid to insurance brokerUSD $214
Total amount of fees paid to insurance companyUSD $15
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $214
Amount paid for insurance broker fees15
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameREUBEN WARNER ASSOCIATES, INC.

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