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VALLEY HEALTH LIFE INSURANCE & LTD PLAN 401k Plan overview

Plan NameVALLEY HEALTH LIFE INSURANCE & LTD PLAN
Plan identification number 501

VALLEY HEALTH LIFE INSURANCE & LTD PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

VALLEY HEALTH has sponsored the creation of one or more 401k plans.

Company Name:VALLEY HEALTH
Employer identification number (EIN):521357729
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about VALLEY HEALTH

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1983-10-07
Company Identification Number: 0247308
Legal Registered Office Address: 220 CAMPUS BLVD STE 420

WINCHESTER
United States of America (USA)
22601

More information about VALLEY HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY HEALTH LIFE INSURANCE & LTD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01PETER F. GALLAGHER
5012016-01-01PETER F. GALLAGHER
5012015-01-01PETER F. GALLAGHER
5012014-01-01PETER F. GALLAGHER
5012013-01-01PETER F. GALLAGHER
5012012-01-01J. CRAIG LEWIS
5012011-01-01J CRAIG LEWIS
5012010-01-01SHELLY BOWMAN-ALLEN
5012009-01-01SHELLY BOWMAN-ALLEN

Plan Statistics for VALLEY HEALTH LIFE INSURANCE & LTD PLAN

401k plan membership statisitcs for VALLEY HEALTH LIFE INSURANCE & LTD PLAN

Measure Date Value
2022: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-015,990
Total number of active participants reported on line 7a of the Form 55002022-01-015,690
Total of all active and inactive participants2022-01-015,690
Total participants2022-01-015,690
2021: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-016,205
Total number of active participants reported on line 7a of the Form 55002021-01-015,990
Total of all active and inactive participants2021-01-015,990
Total participants2021-01-015,990
2020: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-015,996
Total number of active participants reported on line 7a of the Form 55002020-01-016,205
Total of all active and inactive participants2020-01-016,205
Total participants2020-01-016,205
2019: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-015,980
Total number of active participants reported on line 7a of the Form 55002019-01-015,996
Total of all active and inactive participants2019-01-015,996
Total participants2019-01-015,996
Number of participants with account balances2019-01-010
2018: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-015,895
Total number of active participants reported on line 7a of the Form 55002018-01-015,980
Total of all active and inactive participants2018-01-015,980
Total participants2018-01-015,980
2017: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-015,603
Total number of active participants reported on line 7a of the Form 55002017-01-015,895
Total of all active and inactive participants2017-01-015,895
Total participants2017-01-015,895
2016: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-015,532
Total number of active participants reported on line 7a of the Form 55002016-01-015,603
Total of all active and inactive participants2016-01-015,603
Total participants2016-01-010
2015: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-015,935
Total number of active participants reported on line 7a of the Form 55002015-01-015,532
Total of all active and inactive participants2015-01-015,532
Total participants2015-01-010
2014: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-015,922
Total number of active participants reported on line 7a of the Form 55002014-01-015,935
Total of all active and inactive participants2014-01-015,935
Total participants2014-01-010
2013: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-015,096
Total number of active participants reported on line 7a of the Form 55002013-01-015,922
Total of all active and inactive participants2013-01-015,922
Total participants2013-01-010
2012: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-014,509
Total number of active participants reported on line 7a of the Form 55002012-01-015,096
Total of all active and inactive participants2012-01-015,096
Total participants2012-01-010
2011: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-014,055
Total number of active participants reported on line 7a of the Form 55002011-01-014,509
Total of all active and inactive participants2011-01-014,509
Total participants2011-01-014,509
2010: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-014,044
Total number of active participants reported on line 7a of the Form 55002010-01-014,055
Total of all active and inactive participants2010-01-014,055
Total participants2010-01-014,055
2009: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-013,772
Total number of active participants reported on line 7a of the Form 55002009-01-014,044
Total of all active and inactive participants2009-01-014,044
Total participants2009-01-014,044

Financial Data on VALLEY HEALTH LIFE INSURANCE & LTD PLAN

Measure Date Value
2010 : VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No

Form 5500 Responses for VALLEY HEALTH LIFE INSURANCE & LTD PLAN

2022: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: VALLEY HEALTH LIFE INSURANCE & LTD PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PALMETTO HEALTHCARE STOP-LOSS PROGRAM (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberSL-015-VH
Policy instance 11
Insurance contract or identification numberSL-015-VH
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Welfare Benefit Premiums Paid to CarrierUSD $382,168
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 numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered5154
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $70,239
Total amount of fees paid to insurance companyUSD $18,345
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,404,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,239
Amount paid for insurance broker fees18345
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered1287
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $91,939
Total amount of fees paid to insurance companyUSD $7,918
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $612,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91,939
Amount paid for insurance broker fees7918
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5351
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $2,722
Total amount of fees paid to insurance companyUSD $673
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $54,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,722
Amount paid for insurance broker fees673
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered7753
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $47,016
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $481,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,016
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966545
Policy instance 5
Insurance contract or identification numberOK 966545
Number of Individuals Covered2262
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $24,772
Total amount of fees paid to insurance companyUSD $1,657
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $123,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,772
Amount paid for insurance broker fees1657
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964937
Policy instance 6
Insurance contract or identification numberFLX964937
Number of Individuals Covered5362
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $20,114
Total amount of fees paid to insurance companyUSD $5,258
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $402,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,114
Amount paid for insurance broker fees5258
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964938
Policy instance 7
Insurance contract or identification numberFLX964938
Number of Individuals Covered3902
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $232,362
Total amount of fees paid to insurance companyUSD $14,897
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,163,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $232,362
Amount paid for insurance broker fees14897
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSHD962144
Policy instance 8
Insurance contract or identification numberSHD962144
Number of Individuals Covered5324
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011610170
Policy instance 9
Insurance contract or identification number0011610170
Number of Individuals Covered960
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $290,538
Total amount of fees paid to insurance companyUSD $27,803
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $320,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $290,538
Amount paid for insurance broker fees27803
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0703223
Policy instance 10
Insurance contract or identification numberR0703223
Number of Individuals Covered2925
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $288,417
Total amount of fees paid to insurance companyUSD $19,584
Other welfare benefits providedGCIEE GRPACCVD GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $842,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $288,379
Amount paid for insurance broker fees19584
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered7739
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $59,442
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $532,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,442
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5295
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $2,779
Total amount of fees paid to insurance companyUSD $879
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $52,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,779
Amount paid for insurance broker fees879
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered1243
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $92,160
Total amount of fees paid to insurance companyUSD $8,705
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $614,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,160
Amount paid for insurance broker fees8705
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered4794
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $72,019
Total amount of fees paid to insurance companyUSD $21,417
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,440,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,019
Amount paid for insurance broker fees21417
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966545
Policy instance 5
Insurance contract or identification numberOK 966545
Number of Individuals Covered2244
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $26,124
Total amount of fees paid to insurance companyUSD $1,953
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $130,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,124
Amount paid for insurance broker fees1953
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964937
Policy instance 6
Insurance contract or identification numberFLX964937
Number of Individuals Covered5302
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $20,617
Total amount of fees paid to insurance companyUSD $6,584
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $412,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,617
Amount paid for insurance broker fees6584
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964938
Policy instance 7
Insurance contract or identification numberFLX964938
Number of Individuals Covered4237
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $231,106
Total amount of fees paid to insurance companyUSD $16,404
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,156,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $231,106
Amount paid for insurance broker fees16404
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSHD962144
Policy instance 8
Insurance contract or identification numberSHD962144
Number of Individuals Covered5280
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011610170
Policy instance 9
Insurance contract or identification number0011610170
Number of Individuals Covered523
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $21,261
Total amount of fees paid to insurance companyUSD $1,546
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,261
Amount paid for insurance broker fees1546
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0703223
Policy instance 10
Insurance contract or identification numberR0703223
Number of Individuals Covered3775
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $80,291
Total amount of fees paid to insurance companyUSD $1,947
Other welfare benefits providedGCIEE GRPACCVD GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $836,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,249
Amount paid for insurance broker fees1947
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012017-000
Policy instance 11
Insurance contract or identification number16-012017-000
Number of Individuals Covered3964
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Welfare Benefit Premiums Paid to CarrierUSD $212,969
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 numberOK 966545
Policy instance 5
Insurance contract or identification numberOK 966545
Number of Individuals Covered2206
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $20,926
Total amount of fees paid to insurance companyUSD $1,101
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $104,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,926
Amount paid for insurance broker fees1101
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964937
Policy instance 6
Insurance contract or identification numberFLX964937
Number of Individuals Covered5251
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $17,770
Total amount of fees paid to insurance companyUSD $3,209
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $355,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,770
Amount paid for insurance broker fees3209
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964938
Policy instance 7
Insurance contract or identification numberFLX964938
Number of Individuals Covered4546
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $176,829
Total amount of fees paid to insurance companyUSD $8,678
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $885,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $176,829
Amount paid for insurance broker fees8678
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSHD962144
Policy instance 8
Insurance contract or identification numberSHD962144
Number of Individuals Covered5240
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186,450
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 numberFML962144
Policy instance 9
Insurance contract or identification numberFML962144
Number of Individuals Covered6180
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered7885
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of fees paid to insurance companyUSD $46,828
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $496,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees46828
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5243
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $2,377
Total amount of fees paid to insurance companyUSD $473
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $47,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,377
Amount paid for insurance broker fees473
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered1147
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $69,995
Total amount of fees paid to insurance companyUSD $4,995
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $466,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,995
Amount paid for insurance broker fees4995
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered4815
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $57,675
Total amount of fees paid to insurance companyUSD $12,368
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,153,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,675
Amount paid for insurance broker fees12368
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered4763
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $61,771
Total amount of fees paid to insurance companyUSD $8,977
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,235,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,771
Amount paid for insurance broker fees8977
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5180
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $2,361
Total amount of fees paid to insurance companyUSD $350
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $47,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,361
Amount paid for insurance broker fees350
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered7467
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $59,147
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $501,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,147
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966545
Policy instance 5
Insurance contract or identification numberOK 966545
Number of Individuals Covered2268
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $21,947
Total amount of fees paid to insurance companyUSD $799
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $109,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,947
Amount paid for insurance broker fees799
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964937
Policy instance 6
Insurance contract or identification numberFLX964937
Number of Individuals Covered5195
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $17,512
Total amount of fees paid to insurance companyUSD $2,589
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $350,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,512
Amount paid for insurance broker fees2589
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964938
Policy instance 7
Insurance contract or identification numberFLX964938
Number of Individuals Covered4762
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $188,395
Total amount of fees paid to insurance companyUSD $7,017
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $946,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188,395
Amount paid for insurance broker fees7017
Additional information about fees paid to insurance brokerSALES AND SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSHD962144
Policy instance 8
Insurance contract or identification numberSHD962144
Number of Individuals Covered5167
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $184,305
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 numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered1100
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $75,143
Total amount of fees paid to insurance companyUSD $3,854
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $500,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,143
Amount paid for insurance broker fees3854
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFML962144
Policy instance 9
Insurance contract or identification numberFML962144
Number of Individuals Covered6046
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,085
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 numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered5221
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $260,649
Total amount of fees paid to insurance companyUSD $31,111
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,450,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $260,649
Amount paid for insurance broker fees31111
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered5200
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $77,242
Total amount of fees paid to insurance companyUSD $6,343
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $514,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,242
Amount paid for insurance broker fees6343
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5211
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $23,361
Total amount of fees paid to insurance companyUSD $1,767
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $151,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,361
Amount paid for insurance broker fees1767
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered7387
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $25,587
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $429,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,587
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered5090
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $250,026
Total amount of fees paid to insurance companyUSD $53,893
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,515,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $250,026
Amount paid for insurance broker fees53893
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered5050
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $76,099
Total amount of fees paid to insurance companyUSD $10,188
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $507,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,099
Amount paid for insurance broker fees10188
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered5062
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $21,719
Total amount of fees paid to insurance companyUSD $2,704
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $140,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,719
Amount paid for insurance broker fees2704
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SRV
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number99225761001
Policy instance 4
Insurance contract or identification number99225761001
Number of Individuals Covered6901
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $39,378
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $411,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,378
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered4700
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $254,852
Total amount of fees paid to insurance companyUSD $24,463
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,529,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $254,852
Amount paid for insurance broker fees24463
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT961227
Policy instance 2
Insurance contract or identification numberVDT961227
Number of Individuals Covered5497
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $82,870
Total amount of fees paid to insurance companyUSD $5,770
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $520,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,870
Amount paid for insurance broker fees5770
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966544
Policy instance 3
Insurance contract or identification numberOK 966544
Number of Individuals Covered4983
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $29,354
Total amount of fees paid to insurance companyUSD $1,267
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $127,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,354
Amount paid for insurance broker fees1267
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SRV
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9922576
Policy instance 4
Insurance contract or identification number9922576
Number of Individuals Covered5792
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $29,196
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $330,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,196
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered5935
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $238,343
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,448,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $238,343
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960669
Policy instance 1
Insurance contract or identification numberFLK960669
Number of Individuals Covered5922
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $214,881
Total amount of fees paid to insurance companyUSD $56,304
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,262,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $214,881
Amount paid for insurance broker fees56304
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number395278G
Policy instance 1
Insurance contract or identification number395278G
Number of Individuals Covered5096
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $210,865
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,179,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $210,865
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SVCS INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number395278G
Policy instance 1
Insurance contract or identification number395278G
Number of Individuals Covered4509
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $184,326
Total amount of fees paid to insurance companyUSD $6,250
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,058,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number395278G
Policy instance 1
Insurance contract or identification number395278G
Number of Individuals Covered4055
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $123,678
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,686,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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