ELITE CASINO RESORTS LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ELITE CASINO RESORTS HEALTH & WELFARE PLAN
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 2 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 187 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 8 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 10 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $1,029 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,029 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 7 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 77 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $5,485 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,029 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,485 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497 |
Policy instance | 6 |
Insurance contract or identification number | 604497 | Number of Individuals Covered | 174 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $16,411 | 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 $82,057 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,411 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495 |
Policy instance | 5 |
Insurance contract or identification number | 604495 | Number of Individuals Covered | 1027 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,797 | 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 $19,242 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,797 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 4 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 207 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,105 | Total amount of fees paid to insurance company | USD $114 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,105 | Amount paid for insurance broker fees | 114 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 3 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 159 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $1,351 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,351 | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCCLOT40956 |
Policy instance | 1 |
Insurance contract or identification number | HCCLOT40956 | Number of Individuals Covered | 185 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $3,663 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $36,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,663 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 417010411562 |
Policy instance | 18 |
Insurance contract or identification number | 417010411562 | Number of Individuals Covered | 355 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $441,254 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 9 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 218 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,567 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,070 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,332 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417007411726 |
Policy instance | 10 |
Insurance contract or identification number | 417007411726 | Number of Individuals Covered | 215 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $2,184 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $21,888 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,184 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417011411562 |
Policy instance | 17 |
Insurance contract or identification number | 417011411562 | Number of Individuals Covered | 355 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $2,369 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $31,277 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,369 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 417009411726 |
Policy instance | 16 |
Insurance contract or identification number | 417009411726 | Number of Individuals Covered | 215 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $343,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 16015034000 |
Policy instance | 15 |
Insurance contract or identification number | 16015034000 | Number of Individuals Covered | 185 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $6,889 | Welfare Benefit Premiums Paid to Carrier | USD $304,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 3812 | Additional information about fees paid to insurance broker | GROUP SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 14 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 170 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,461 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,634 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,461 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EKF54 |
Policy instance | 13 |
Insurance contract or identification number | EKF54 | Number of Individuals Covered | 56 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $7,312 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $35,713 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,645 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 12 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 34 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,706 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $25,341 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,236 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 11 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 99 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $20,006 | Total amount of fees paid to insurance company | USD $481 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $84,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 121 | Additional information about fees paid to insurance broker | BONUSES |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 9 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 206 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,579 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,438 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,342 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 8 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 10 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $821 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $821 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 7 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 82 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $4,584 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,925 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,584 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497 |
Policy instance | 6 |
Insurance contract or identification number | 604497 | Number of Individuals Covered | 187 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $17,600 | 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 $87,998 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,600 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495 |
Policy instance | 5 |
Insurance contract or identification number | 604495 | Number of Individuals Covered | 1007 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,175 | 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 $24,902 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,175 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 3 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 164 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $1,353 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,353 | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCCLOT40956 |
Policy instance | 1 |
Insurance contract or identification number | HCCLOT40956 | Number of Individuals Covered | 194 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $3,856 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $38,566 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,856 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 4 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 207 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,276 | Total amount of fees paid to insurance company | USD $134 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,276 | Amount paid for insurance broker fees | 134 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417007411726 |
Policy instance | 10 |
Insurance contract or identification number | 417007411726 | Number of Individuals Covered | 210 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $2,274 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $22,752 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,274 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 11 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 111 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $10,711 | Total amount of fees paid to insurance company | USD $161 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $67,304 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,506 | Amount paid for insurance broker fees | 35 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 2 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 190 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 417010411562 |
Policy instance | 18 |
Insurance contract or identification number | 417010411562 | Number of Individuals Covered | 257 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $385,579 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417011411562 |
Policy instance | 17 |
Insurance contract or identification number | 417011411562 | Number of Individuals Covered | 323 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $2,491 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $24,502 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,491 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 417009411726 |
Policy instance | 16 |
Insurance contract or identification number | 417009411726 | Number of Individuals Covered | 210 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $340,993 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 12 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 29 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,945 | Total amount of fees paid to insurance company | USD $34 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $21,434 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $736 | Amount paid for insurance broker fees | 28 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 16015034000 |
Policy instance | 15 |
Insurance contract or identification number | 16015034000 | Number of Individuals Covered | 194 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $5,189 | Welfare Benefit Premiums Paid to Carrier | USD $304,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 5189 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EKF54 |
Policy instance | 13 |
Insurance contract or identification number | EKF54 | Number of Individuals Covered | 47 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,960 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $23,310 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $912 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 14 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 183 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,592 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,926 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,592 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 3 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 176 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $1,448 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,504 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,448 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 16015034000 |
Policy instance | 15 |
Insurance contract or identification number | 16015034000 | Number of Individuals Covered | 204 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $6,460 | Welfare Benefit Premiums Paid to Carrier | USD $338,638 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 6460 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 417009411726 |
Policy instance | 16 |
Insurance contract or identification number | 417009411726 | Number of Individuals Covered | 369 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $346,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417011411562 |
Policy instance | 17 |
Insurance contract or identification number | 417011411562 | Number of Individuals Covered | 397 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $2,750 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $27,505 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,750 | Insurance broker organization code? | 3 |
|
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 16015035000 |
Policy instance | 18 |
Insurance contract or identification number | 16015035000 | Number of Individuals Covered | 275 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $7,848 | Welfare Benefit Premiums Paid to Carrier | USD $413,039 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 7848 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCCLOT40956 |
Policy instance | 1 |
Insurance contract or identification number | HCCLOT40956 | Number of Individuals Covered | 226 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $4,515 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $45,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,515 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 14 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 187 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $3,578 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,578 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EKF54 |
Policy instance | 13 |
Insurance contract or identification number | EKF54 | Number of Individuals Covered | 37 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,658 | Total amount of fees paid to insurance company | USD $215 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $24,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,300 | Amount paid for insurance broker fees | 168 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 12 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 34 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,105 | Total amount of fees paid to insurance company | USD $23 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $20,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $848 | Amount paid for insurance broker fees | 16 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417007411726 |
Policy instance | 10 |
Insurance contract or identification number | 417007411726 | Number of Individuals Covered | 367 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $2,438 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $24,355 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,438 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 8 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 8 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $743 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,953 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $743 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 7 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 95 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $4,569 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,177 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,569 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497 |
Policy instance | 6 |
Insurance contract or identification number | 604497 | Number of Individuals Covered | 185 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $15,984 | 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 $83,080 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,984 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495 |
Policy instance | 5 |
Insurance contract or identification number | 604495 | Number of Individuals Covered | 1149 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,191 | 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 $26,018 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,191 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 4 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 231 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $3,911 | Total amount of fees paid to insurance company | USD $314 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,911 | Amount paid for insurance broker fees | 49 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 9 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 222 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,389 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,848 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,389 | Insurance broker organization code? | 3 |
|
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 2 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 202 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 11 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 93 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $9,724 | Total amount of fees paid to insurance company | USD $786 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $71,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,148 | Amount paid for insurance broker fees | 420 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 18 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 228 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,669 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,339 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,419 | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCCLOT40956 |
Policy instance | 1 |
Insurance contract or identification number | HCCLOT40956 | Number of Individuals Covered | 257 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $4,704 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $47,036 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,704 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 241514 |
Policy instance | 2 |
Insurance contract or identification number | 241514 | Number of Individuals Covered | 250 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $4,558 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $327,352 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,039 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 4 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 197 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $1,506 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,314 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,109 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495 |
Policy instance | 6 |
Insurance contract or identification number | 604495 | Number of Individuals Covered | 1254 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,343 | 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 $26,479 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,343 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497 |
Policy instance | 7 |
Insurance contract or identification number | 604497 | Number of Individuals Covered | 199 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $15,435 | 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 $75,974 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,435 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 230776 |
Policy instance | 8 |
Insurance contract or identification number | 230776 | Number of Individuals Covered | 314 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $3,214 | Welfare Benefit Premiums Paid to Carrier | USD $445,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 3214 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCCLOT40970 |
Policy instance | 9 |
Insurance contract or identification number | HCCLOT40970 | Number of Individuals Covered | 317 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $5,374 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $53,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,374 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 5 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 242 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $3,589 | Total amount of fees paid to insurance company | USD $296 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,707 | Amount paid for insurance broker fees | 296 | Additional information about fees paid to insurance broker | SALES AND PERSISTENCY BONUS | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 10 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 98 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $4,406 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,152 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,406 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 11 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 9 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $727 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,848 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $727 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 12 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 177 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,858 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,969 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,858 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 417005411726 |
Policy instance | 13 |
Insurance contract or identification number | 417005411726 | Number of Individuals Covered | 243 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $348,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417007411726 |
Policy instance | 14 |
Insurance contract or identification number | 417007411726 | Number of Individuals Covered | 231 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $2,188 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $21,878 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,188 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 15 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 155 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $16,225 | Total amount of fees paid to insurance company | USD $990 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $89,705 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,590 | Amount paid for insurance broker fees | 115 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 16 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 38 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,890 | Total amount of fees paid to insurance company | USD $52 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $29,140 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,149 | Amount paid for insurance broker fees | 42 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EKF54 |
Policy instance | 17 |
Insurance contract or identification number | EKF54 | Number of Individuals Covered | 40 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,527 | Total amount of fees paid to insurance company | USD $49 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $31,967 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,386 | Amount paid for insurance broker fees | 41 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 3 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 264 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0001 |
Policy instance | 18 |
Insurance contract or identification number | 604495-0001 | Number of Individuals Covered | 338 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $508 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $508 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 19 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 88 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $3,073 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,073 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 20 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 56 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $1,704 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,360 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,704 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 21 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 10 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $780 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,197 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $780 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0001 |
Policy instance | 23 |
Insurance contract or identification number | 604497-0001 | Number of Individuals Covered | 92 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $8,214 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,069 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,214 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0001 |
Policy instance | 22 |
Insurance contract or identification number | 604497-0001 | Number of Individuals Covered | 36 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $329 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $329 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 24 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 197 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,464 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,642 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,464 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0004 |
Policy instance | 27 |
Insurance contract or identification number | 604495-0004 | Number of Individuals Covered | 9 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $30 | 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 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 901407 |
Policy instance | 25 |
Insurance contract or identification number | 901407 | Number of Individuals Covered | 231 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $26,937 | Total amount of fees paid to insurance company | USD $2,499 | Welfare Benefit Premiums Paid to Carrier | USD $359,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,958 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2499 | Additional information about fees paid to insurance broker | BONUSES |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 1000931 |
Policy instance | 26 |
Insurance contract or identification number | 1000931 | Number of Individuals Covered | 370 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $19,476 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0004 |
Policy instance | 28 |
Insurance contract or identification number | 604495-0004 | Number of Individuals Covered | 9 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $14 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $142 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0004 |
Policy instance | 29 |
Insurance contract or identification number | 604497-0004 | Number of Individuals Covered | 1 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $17 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $81 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0004 |
Policy instance | 30 |
Insurance contract or identification number | 604497-0004 | Number of Individuals Covered | 2 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $210 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $968 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $210 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 31 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 43 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,741 | Total amount of fees paid to insurance company | USD $159 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $28,735 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $737 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 113 | Additional information about fees paid to insurance broker | BONUSES |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 32 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 138 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $14,021 | Total amount of fees paid to insurance company | USD $685 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $78,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,018 | Amount paid for insurance broker fees | 251 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0002 |
Policy instance | 16 |
Insurance contract or identification number | 604495-0002 | Number of Individuals Covered | 491 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $703 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,924 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $703 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0001 |
Policy instance | 17 |
Insurance contract or identification number | 604495-0001 | Number of Individuals Covered | 338 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $111 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,268 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $111 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0002 |
Policy instance | 15 |
Insurance contract or identification number | 604495-0002 | Number of Individuals Covered | 491 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $156 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,740 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $156 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 241514 |
Policy instance | 2 |
Insurance contract or identification number | 241514 | Number of Individuals Covered | 278 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $22,215 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $326,391 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,810 | Insurance broker organization code? | 3 |
|
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 3 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 257 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 4 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 212 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $1,471 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,814 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,471 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 5 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 249 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,999 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,999 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0003 |
Policy instance | 6 |
Insurance contract or identification number | 604495-0003 | Number of Individuals Covered | 410 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $115 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,260 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $115 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0003 |
Policy instance | 7 |
Insurance contract or identification number | 604495-0003 | Number of Individuals Covered | 410 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $513 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,922 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $513 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0003 |
Policy instance | 8 |
Insurance contract or identification number | 604497-0003 | Number of Individuals Covered | 27 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $212 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,079 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $212 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 10 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 231 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,664 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,414 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0003 |
Policy instance | 9 |
Insurance contract or identification number | 604497-0003 | Number of Individuals Covered | 46 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,549 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,549 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 230776 |
Policy instance | 11 |
Insurance contract or identification number | 230776 | Number of Individuals Covered | 320 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $36,315 | Total amount of fees paid to insurance company | USD $5,925 | Welfare Benefit Premiums Paid to Carrier | USD $484,201 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,210 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 5925 | Additional information about fees paid to insurance broker | BONUSES |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 947-6653 |
Policy instance | 12 |
Insurance contract or identification number | 947-6653 | Number of Individuals Covered | 291 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $5,351 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $53,507 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,971 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0002 |
Policy instance | 13 |
Insurance contract or identification number | 604497-0002 | Number of Individuals Covered | 16 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $150 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $751 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $150 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0002 |
Policy instance | 14 |
Insurance contract or identification number | 604497-0002 | Number of Individuals Covered | 60 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $5,099 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,099 | Insurance broker organization code? | 3 |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 947-6652 |
Policy instance | 1 |
Insurance contract or identification number | 947-6652 | Number of Individuals Covered | 256 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $4,722 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $47,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,248 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0004 |
Policy instance | 31 |
Insurance contract or identification number | 604497-0004 | Number of Individuals Covered | 1 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $16 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $87 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12298217 |
Policy instance | 11 |
Insurance contract or identification number | 12298217 | Number of Individuals Covered | 220 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,513 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 20 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 88 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $3,874 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $38,428 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 947-5128 |
Policy instance | 1 |
Insurance contract or identification number | 947-5128 | Number of Individuals Covered | 238 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $4,422 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $44,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 23 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 14 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-07-01 | Total amount of commissions paid to insurance broker | USD $202 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,602 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601888 |
Policy instance | 21 |
Insurance contract or identification number | 601888 | Number of Individuals Covered | 90 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-07-01 | Total amount of commissions paid to insurance broker | USD $2,391 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 ) |
Policy contract number | 483 |
Policy instance | 3 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 244 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 601887 |
Policy instance | 22 |
Insurance contract or identification number | 601887 | Number of Individuals Covered | 10 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $886 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EYQ55 |
Policy instance | 35 |
Insurance contract or identification number | EYQ55 | Number of Individuals Covered | 104 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $13,290 | Total amount of fees paid to insurance company | USD $691 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $75,708 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | HXS70 |
Policy instance | 34 |
Insurance contract or identification number | HXS70 | Number of Individuals Covered | 50 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $7,356 | Total amount of fees paid to insurance company | USD $449 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $35,594 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 7413 |
Policy instance | 33 |
Insurance contract or identification number | 7413 | Number of Individuals Covered | 69 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,278 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT AND CANC | Welfare Benefit Premiums Paid to Carrier | USD $16,510 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0004 |
Policy instance | 32 |
Insurance contract or identification number | 604497-0004 | Number of Individuals Covered | 2 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $193 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,049 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0004 |
Policy instance | 30 |
Insurance contract or identification number | 604495-0004 | Number of Individuals Covered | 8 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $12 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $121 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0004 |
Policy instance | 29 |
Insurance contract or identification number | 604495-0004 | Number of Individuals Covered | 8 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $3 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $30 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 417007411726 |
Policy instance | 28 |
Insurance contract or identification number | 417007411726 | Number of Individuals Covered | 233 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $2,175 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $21,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 901407 |
Policy instance | 27 |
Insurance contract or identification number | 901407 | Number of Individuals Covered | 229 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $28,443 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $379,230 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30046807 |
Policy instance | 26 |
Insurance contract or identification number | 30046807 | Number of Individuals Covered | 203 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $3,427 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,275 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0001 |
Policy instance | 25 |
Insurance contract or identification number | 604497-0001 | Number of Individuals Covered | 98 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $6,480 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0001 |
Policy instance | 19 |
Insurance contract or identification number | 604495-0001 | Number of Individuals Covered | 361 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $639 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,339 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0001 |
Policy instance | 18 |
Insurance contract or identification number | 604495-0001 | Number of Individuals Covered | 361 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $160 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,335 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 241514 |
Policy instance | 2 |
Insurance contract or identification number | 241514 | Number of Individuals Covered | 244 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $25,397 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $338,626 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 ) |
Policy contract number | 483 |
Policy instance | 4 |
Insurance contract or identification number | 483 | Number of Individuals Covered | 0 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025643 |
Policy instance | 5 |
Insurance contract or identification number | 30025643 | Number of Individuals Covered | 186 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $1,422 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,711 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
Policy contract number | 40022 |
Policy instance | 6 |
Insurance contract or identification number | 40022 | Number of Individuals Covered | 255 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,755 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0003 |
Policy instance | 7 |
Insurance contract or identification number | 604495-0003 | Number of Individuals Covered | 388 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $149 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,349 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0003 |
Policy instance | 8 |
Insurance contract or identification number | 604495-0003 | Number of Individuals Covered | 388 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $598 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,396 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0003 |
Policy instance | 9 |
Insurance contract or identification number | 604497-0003 | Number of Individuals Covered | 26 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $235 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,255 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0003 |
Policy instance | 10 |
Insurance contract or identification number | 604497-0003 | Number of Individuals Covered | 46 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,929 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 230776 |
Policy instance | 12 |
Insurance contract or identification number | 230776 | Number of Individuals Covered | 335 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $37,402 | Total amount of fees paid to insurance company | USD $3,668 | Welfare Benefit Premiums Paid to Carrier | USD $498,692 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 947-5288 |
Policy instance | 13 |
Insurance contract or identification number | 947-5288 | Number of Individuals Covered | 0 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $5,412 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT | Welfare Benefit Premiums Paid to Carrier | USD $54,119 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0002 |
Policy instance | 14 |
Insurance contract or identification number | 604497-0002 | Number of Individuals Covered | 17 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $155 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $705 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0002 |
Policy instance | 15 |
Insurance contract or identification number | 604497-0002 | Number of Individuals Covered | 61 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $4,716 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,578 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0002 |
Policy instance | 16 |
Insurance contract or identification number | 604495-0002 | Number of Individuals Covered | 482 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $195 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604495-0002 |
Policy instance | 17 |
Insurance contract or identification number | 604495-0002 | Number of Individuals Covered | 482 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $771 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 604497-0001 |
Policy instance | 24 |
Insurance contract or identification number | 604497-0001 | Number of Individuals Covered | 41 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $293 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $1,464 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|