SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN
401k plan membership statisitcs for SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2022: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 545 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 478 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 479 |
| 2021: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 535 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 369 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 161 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 15 |
| Total of all active and inactive participants | 2021-01-01 | 545 |
| 2020: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 545 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 373 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 162 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 535 |
| 2019: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 565 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 369 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 176 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 545 |
| 2018: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 568 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 380 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 185 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 565 |
| 2017: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 624 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 399 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 169 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 568 |
| 2016: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 650 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 416 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 208 |
| Total of all active and inactive participants | 2016-01-01 | 624 |
| Total participants | 2016-01-01 | 624 |
| 2015: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 650 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 430 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 220 |
| Total of all active and inactive participants | 2015-01-01 | 650 |
| Total participants | 2015-01-01 | 0 |
| 2014: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 630 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 424 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 226 |
| Total of all active and inactive participants | 2014-01-01 | 650 |
| Total participants | 2014-01-01 | 0 |
| 2013: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 614 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 404 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 226 |
| Total of all active and inactive participants | 2013-01-01 | 630 |
| Total participants | 2013-01-01 | 0 |
| 2012: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 576 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 398 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 216 |
| Total of all active and inactive participants | 2012-01-01 | 614 |
| Total participants | 2012-01-01 | 0 |
| 2011: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 556 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 382 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 194 |
| Total of all active and inactive participants | 2011-01-01 | 576 |
| Total participants | 2011-01-01 | 576 |
| 2009: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 660 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 369 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 149 |
| Total of all active and inactive participants | 2009-01-01 | 518 |
| Total participants | 2009-01-01 | 518 |
| 2022: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: SOUTHERN MARYLAND ELECTRIC COOPERATIVE, INC. NON-PROFIT EMPLOYEE HEALTH CARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 71714 ) |
| Policy contract number | C32121 |
| Policy instance | 5 |
| Insurance contract or identification number | C32121 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $-3,979 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPPLEMENTAL DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-241 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | AGENCY HEAD COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,400 | | Total amount of fees paid to insurance company | USD $324 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,354 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,400 | | Amount paid for insurance broker fees | 8 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $50,230 | | Total amount of fees paid to insurance company | USD $4,806 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPP. LIFE & DEP. LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $271,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,230 | | Amount paid for insurance broker fees | 124 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Total amount of fees paid to insurance company | USD $66 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,628 | | Amount paid for insurance broker fees | 3 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,124 | | Total amount of fees paid to insurance company | USD $2,719 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $147,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,124 | | Amount paid for insurance broker fees | 72 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 362 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $13,579 | | Total amount of fees paid to insurance company | USD $1,414 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $149,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,579 | | Amount paid for insurance broker fees | 1414 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 463 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Total amount of fees paid to insurance company | USD $79 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,628 | | Amount paid for insurance broker fees | 79 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $40,975 | | Total amount of fees paid to insurance company | USD $2,523 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPP. LIFE & DEP. LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $265,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,975 | | Amount paid for insurance broker fees | 2523 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,764 | | Total amount of fees paid to insurance company | USD $170 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,764 | | Amount paid for insurance broker fees | 170 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 71714 ) |
| Policy contract number | C32121 |
| Policy instance | 5 |
| Insurance contract or identification number | C32121 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $22,119 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPPLEMENTAL DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,830 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK961918 | | Number of Individuals Covered | 458 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $15,807 | | Total amount of fees paid to insurance company | USD $1,404 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $158,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,807 | | Amount paid for insurance broker fees | 1404 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Total amount of fees paid to insurance company | USD $78 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $8,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,628 | | Amount paid for insurance broker fees | 78 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 757 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $47,892 | | Total amount of fees paid to insurance company | USD $2,296 | | Other welfare benefits provided | BASIC LIFE, SUPP. LIFE & DEP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $281,717 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,892 | | Amount paid for insurance broker fees | 2296 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $3,224 | | Total amount of fees paid to insurance company | USD $168 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $18,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,224 | | Amount paid for insurance broker fees | 168 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 1132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $52,513 | | Welfare Benefit Premiums Paid to Carrier | USD $874,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,362 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961269 |
| Policy instance | 6 |
| Insurance contract or identification number | AI961269 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,453 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $9,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,453 | | Additional information about fees paid to insurance broker | STANDARD COMMISSIONS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961217 |
| Policy instance | 7 |
| Insurance contract or identification number | CI961217 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,606 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $10,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,606 | | Additional information about fees paid to insurance broker | STANDARD COMMISSIONS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960597 |
| Policy instance | 8 |
| Insurance contract or identification number | HC960597 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,313 | | Other welfare benefits provided | VOLUNTARY HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $8,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,313 | | Additional information about fees paid to insurance broker | STANDARD COMMISSIONS | | Insurance broker organization code? | 3 |
|
| BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 71714 ) |
| Policy contract number | C32121 |
| Policy instance | 9 |
| Insurance contract or identification number | C32121 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $20,680 | | Other welfare benefits provided | SUPPLEMENTAL DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $70,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,233 | | Additional information about fees paid to insurance broker | SALES SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $16,713 | | Total amount of fees paid to insurance company | USD $1,186 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,713 | | Amount paid for insurance broker fees | 1186 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $1,714 | | Total amount of fees paid to insurance company | USD $53 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $8,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,714 | | Amount paid for insurance broker fees | 53 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 324 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $50,268 | | Total amount of fees paid to insurance company | USD $2,031 | | Other welfare benefits provided | BASIC LIFE, SUPP. LIFE & DEP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $295,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,268 | | Amount paid for insurance broker fees | 2031 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $3,400 | | Total amount of fees paid to insurance company | USD $143 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $20,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,400 | | Amount paid for insurance broker fees | 143 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 546 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $52,693 | | Welfare Benefit Premiums Paid to Carrier | USD $954,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,693 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $14,571 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $145,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,571 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 326 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $42,514 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $250,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,514 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $2,969 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $17,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,969 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $53,381 | | Welfare Benefit Premiums Paid to Carrier | USD $911,797 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,381 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 579 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $35,782 | | Welfare Benefit Premiums Paid to Carrier | USD $709,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,782 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 467 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $3,504 | | Total amount of fees paid to insurance company | USD $248 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $20,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,504 | | Amount paid for insurance broker fees | 248 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 348 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $47,277 | | Total amount of fees paid to insurance company | USD $2,386 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $278,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,277 | | Amount paid for insurance broker fees | 2386 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 467 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $101 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 101 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $16,803 | | Total amount of fees paid to insurance company | USD $2,029 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,803 | | Amount paid for insurance broker fees | 2029 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPPORT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 504 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $14,865 | | Total amount of fees paid to insurance company | USD $1,076 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $148,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,865 | | Amount paid for insurance broker fees | 1076 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $58 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 58 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $29,889 | | Total amount of fees paid to insurance company | USD $1,282 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $175,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,889 | | Amount paid for insurance broker fees | 1282 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $3,108 | | Total amount of fees paid to insurance company | USD $133 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $18,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,108 | | Amount paid for insurance broker fees | 133 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 601 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $35,013 | | Welfare Benefit Premiums Paid to Carrier | USD $642,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,013 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 363 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $29,038 | | Total amount of fees paid to insurance company | USD $1,241 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $170,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,038 | | Amount paid for insurance broker fees | 1241 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 501 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $14,501 | | Total amount of fees paid to insurance company | USD $1,182 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,501 | | Amount paid for insurance broker fees | 1182 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 487 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $3,015 | | Total amount of fees paid to insurance company | USD $129 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $17,706 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,015 | | Amount paid for insurance broker fees | 129 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332310 |
| Policy instance | 5 |
| Insurance contract or identification number | 3332310 | | Number of Individuals Covered | 617 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $28,758 | | Welfare Benefit Premiums Paid to Carrier | USD $571,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,758 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 487 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $2 | | Total amount of fees paid to insurance company | USD $58 | | Other welfare benefits provided | ACCIDENTAL DEATH | | 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 | | Amount paid for insurance broker fees | 58 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 2 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 473 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $4,679 | | Total amount of fees paid to insurance company | USD $-19 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $23,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,679 | | Amount paid for insurance broker fees | -19 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $16,086 | | Total amount of fees paid to insurance company | USD $-383 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $157,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,086 | | Amount paid for insurance broker fees | -383 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 473 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $2,943 | | Total amount of fees paid to insurance company | USD $-41 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $17,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,943 | | Amount paid for insurance broker fees | -41 | | Additional information about fees paid to insurance broker | SALES, SERVICE AND SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 3 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $28,374 | | Total amount of fees paid to insurance company | USD $-391 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $164,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,374 | | Amount paid for insurance broker fees | -391 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 4 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $17,399 | | Total amount of fees paid to insurance company | USD $383 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $162,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,399 | | Amount paid for insurance broker fees | 383 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 3 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 464 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $57 | | Total amount of fees paid to insurance company | USD $19 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57 | | Amount paid for insurance broker fees | 19 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 2 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 356 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $29,227 | | Total amount of fees paid to insurance company | USD $391 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $165,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,227 | | Amount paid for insurance broker fees | 391 | | Additional information about fees paid to insurance broker | SALES, SERVICE & SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 1 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 464 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $3,025 | | Total amount of fees paid to insurance company | USD $41 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $17,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,025 | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | SALES, SERVICE AND SUPP. COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF MARYLAND, INC. |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 961918 |
| Policy instance | 4 |
| Insurance contract or identification number | LK 961918 | | Number of Individuals Covered | 472 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $14,525 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,988 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962384 |
| Policy instance | 3 |
| Insurance contract or identification number | ABL962384 | | Number of Individuals Covered | 441 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $95 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 1 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 441 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $2,478 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 2 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $23,739 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $131,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK961918 |
| Policy instance | 4 |
| Insurance contract or identification number | LK961918 | | Number of Individuals Covered | 464 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $16,853 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964261 |
| Policy instance | 1 |
| Insurance contract or identification number | OK 964261 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $3,072 | | Other welfare benefits provided | MEDICAL INDEMNITY ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $15,865 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLI960107 |
| Policy instance | 2 |
| Insurance contract or identification number | FLI960107 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $29,688 | | Other welfare benefits provided | SUPPLEMENTAL LIFE & DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $153,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL 962384 |
| Policy instance | 3 |
| Insurance contract or identification number | ABL 962384 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $4,660 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $22,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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