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GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 401k Plan overview

Plan NameGROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN
Plan identification number 501

GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN Benefits

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

401k Sponsoring company profile

KANSAS BANKERS SERVICES, INC. GROUP TERM DEPENDENT CARE LIFE PLAN has sponsored the creation of one or more 401k plans.

Company Name:KANSAS BANKERS SERVICES, INC. GROUP TERM DEPENDENT CARE LIFE PLAN
Employer identification number (EIN):481233705
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-08-01ELIZABETH ROCHE2023-02-02
5012020-08-01ELIZABETH ROCHE2021-11-22
5012019-08-01EDWARD GRIFFITH2021-02-01
5012018-08-01EDWARD GRIFFITH2020-02-04
5012017-08-01
5012016-08-01
5012015-08-01
5012014-08-01
5012013-08-01
5012012-08-01EDWARD GRIFFITH
5012011-08-01EDWARD GRIFFITH
5012009-08-01EDWARD GRIFFITH

Plan Statistics for GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN

401k plan membership statisitcs for GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN

Measure Date Value
2021: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-016,405
Total number of active participants reported on line 7a of the Form 55002021-08-016,431
Total of all active and inactive participants2021-08-016,431
2020: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-016,343
Total number of active participants reported on line 7a of the Form 55002020-08-016,405
Total of all active and inactive participants2020-08-016,405
2019: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-016,350
Total number of active participants reported on line 7a of the Form 55002019-08-016,343
Total of all active and inactive participants2019-08-016,343
2018: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-016,721
Total number of active participants reported on line 7a of the Form 55002018-08-016,350
Total of all active and inactive participants2018-08-016,350
2017: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-017,229
Total number of active participants reported on line 7a of the Form 55002017-08-016,721
Total of all active and inactive participants2017-08-016,721
2016: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-017,100
Total number of active participants reported on line 7a of the Form 55002016-08-017,229
Total of all active and inactive participants2016-08-017,229
2015: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-017,333
Total number of active participants reported on line 7a of the Form 55002015-08-017,100
Total of all active and inactive participants2015-08-017,100
2014: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-017,365
Total number of active participants reported on line 7a of the Form 55002014-08-017,333
Total of all active and inactive participants2014-08-017,333
2013: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-017,414
Total number of active participants reported on line 7a of the Form 55002013-08-017,365
Total of all active and inactive participants2013-08-017,365
2012: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-017,297
Total number of active participants reported on line 7a of the Form 55002012-08-017,414
Total of all active and inactive participants2012-08-017,414
2011: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-017,505
Total number of active participants reported on line 7a of the Form 55002011-08-017,297
Total of all active and inactive participants2011-08-017,297
2009: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-018,430
Total number of active participants reported on line 7a of the Form 55002009-08-017,871
Total of all active and inactive participants2009-08-017,871

Form 5500 Responses for GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN

2021: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2021 form 5500 responses
2021-08-01Type of plan entityMulitple employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – InsuranceYes
2020: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2020 form 5500 responses
2020-08-01Type of plan entityMulitple employer plan
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – InsuranceYes
2019: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2019 form 5500 responses
2019-08-01Type of plan entityMulitple employer plan
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – InsuranceYes
2018: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2018 form 5500 responses
2018-08-01Type of plan entityMulitple employer plan
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – InsuranceYes
2017: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2017 form 5500 responses
2017-08-01Type of plan entityMulitple employer plan
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2016 form 5500 responses
2016-08-01Type of plan entityMulitple employer plan
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2015 form 5500 responses
2015-08-01Type of plan entityMulitple employer plan
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2014 form 5500 responses
2014-08-01Type of plan entityMulitple employer plan
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2013 form 5500 responses
2013-08-01Type of plan entityMulitple employer plan
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2012 form 5500 responses
2012-08-01Type of plan entityMulitple employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2011 form 5500 responses
2011-08-01Type of plan entityMulitple employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: GROUP TERM LIFE, A D & D, AND DEPENDENT LIFE PLAN 2009 form 5500 responses
2009-08-01Type of plan entityMulitple employer plan
2009-08-01This submission is the final filingNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered6431
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $160,446
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,087,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $160,446
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered6405
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $10,005
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $200,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,005
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered6405
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $9,809
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $196,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,809
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered6377
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $159,357
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,245,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $159,357
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered6321
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $140,246
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,045,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,246
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered6343
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $9,800
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $196,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,800
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered6361
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $9,757
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $178,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,757
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered6350
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $156,742
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,246,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $156,742
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered6477
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $191,665
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,505,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered6721
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $10,338
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $206,760
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 number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered7079
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $112,323
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,389,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $112,323
Insurance broker nameKBA INSURANCE INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered7100
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $10,476
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $209,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,476
Insurance broker organization code?3
Insurance broker nameKANSAS BANKERS ASSOCIATION
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered7333
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $165,131
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,393,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $165,131
Insurance broker nameKBA INSURANCE INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered7333
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $9,682
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $193,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,682
Insurance broker organization code?3
Insurance broker nameKANSAS BANKERS ASSOCIATION
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered7236
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $10,544
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $210,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,544
Insurance broker organization code?3
Insurance broker nameKANSAS BANKERS ASSOCIATION
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered7365
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $161,534
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,341,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $161,534
Insurance broker nameKBA INSURANCE INC
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered7380
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $10,525
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $210,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,525
Insurance broker organization code?3
Insurance broker nameKANSAS BANKERS ASSOCIATION
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered7414
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $105,996
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,536,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $105,996
Insurance broker nameKBA INSURANCE INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number215840
Policy instance 3
Insurance contract or identification number215840
Number of Individuals Covered330
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $298,665
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,333,328
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 number215840
Policy instance 2
Insurance contract or identification number215840
Number of Individuals Covered7297
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $136,021
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,037,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered7249
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $10,341
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $206,828
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 number215840
Policy instance 4
Insurance contract or identification number215840
Number of Individuals Covered7505
Insurance policy start date2011-02-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $58,161
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,057,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number642068
Policy instance 3
Insurance contract or identification number642068
Number of Individuals Covered688
Insurance policy start date2010-08-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $13,183
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number122894
Policy instance 2
Insurance contract or identification number122894
Number of Individuals Covered7634
Insurance policy start date2010-08-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $95,995
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU-8364002
Policy instance 1
Insurance contract or identification numberGTU-8364002
Number of Individuals Covered99
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $10,498
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBASIC AD & D
Welfare Benefit Premiums Paid to CarrierUSD $209,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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